Long-Term Liver Disease, Treatment, and Mortality Outcomes Among 17,000 Persons Diagnosed with Chronic Hepatitis C Virus Infection

Moorman, Anne C.; Rupp, Loralee B; Gordon, Stuart C.; Zhong, Yuna; Xing, Jian; Lü, Mei; Boscarino, Joseph A.; Schmidt, Mark; Daida, Yihe G.; Teshale, Eyasu H.; Spradling, Philip R.; Holmberg, Scott D.

doi:10.1016/j.idc.2018.02.002

Cited by 21 publications

(16 citation statements)

References 33 publications

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“…The criteria for cohort inclusion and analytic methods involved in its derivation have been described in detail. (18,19) The cohort was created based on analysis of electronic health records and administrative data (supplemented with individual chart review) of approximately 2.7 million patients aged ≥18 years who had at least one clinical service visit (i.e., outpatient or inpatient, emergency department, or laboratory test) from January 1, 2006, to December 31, 2013. Patients who met a combination of laboratory-based (i.e., positive HCV RNA) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-based criteria identifying them as having chronic HCV infection were included.…”

Section: Study Populationmentioning

confidence: 99%

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

et al. 2020

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for the Chronic Hepatitis Cohort Study (CHeCS) Investigators There are limited data examining the relationship between psychosocial factors and receipt of direct-acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health-related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017-2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow-up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life-related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow-up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). Conclusion: In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C-related morbidity and mortality. (Hepatology Communications 2020;0:1-12). P ublic health prevention and control of hepatitis C entails identification of infected persons through universal testing, followed by linkage to clinical services and ensuring that persons linked to care receive and complete effective treatment. (1-5) On an individual level, eradication of hepatitis C virus (HCV) infection eliminates the possibility of HCV transmission to others and reduces morbidity and mortality from HCVattributable hepatic and extrahepatic disease among persons who no longer engage in transmission-associated behaviors. (4) Despite radical improvement in the treatment of HCV infection since the release of secondgeneration direct-acting antiviral (DAA) medications, uptake of these drugs in many U.S. general health care

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Section: Study Populationmentioning

confidence: 99%

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

et al. 2020

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“…Those with HCV were on average 10 years older at the time of viral hepatitis diagnosis and at HCC diagnosis than those with HBV, which is consistent with the most common risk factors for HBV and HCV infection in NYC; among those with HCV, injection and intranasal drug use are some of the most commonly reported risk factors [ 22 ], whereas most individuals with HBV in NYC were born in HBV-endemic countries and likely acquired their infections at birth or as children [ 23 ]. The older age at diagnosis for individuals with HCV implies that many of these individuals lived for many years with undetected infection, delaying the receipt of appropriate medical care, screening opportunities, chances for treatment initiation, and other measures that could have limited negative health consequences associated with delayed diagnosis, which include hospitalization (all cause), advanced liver disease, and death (all cause) [ 24 ]. Our finding that the odds of an HCC diagnosis increases with increasing age at viral hepatitis diagnosis reinforces this point.…”

Section: Discussionmentioning

confidence: 99%

“…The magnitude of the association between each of these conditions with death was much larger for those with HBV than those with HCV; at the same time, those with HCV had an increased risk of death compared with those with HBV regardless of HCC/HIV status. This suggests that HIV and HCC might be more substantial drivers of mortality for HBV-infected individuals who experience these conditions, whereas HCV-infected individuals in this study might have more competing sources of mortality, especially given the older age of this cohort [ 24 ]. Supporting this finding is that among HBV-infected individuals with HCC, 74.3% of those who died during the study period died of HCC, compared with 65.9% of those with HCV and HCC, consistent with studies showing that those with HBV have a higher risk of liver-related mortality than those with HCV, and with our previous investigation into this population [ 8 , 18 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Hepatocellular Carcinoma on Mortality Among Individuals With Hepatitis B or Hepatitis C Infection in New York City, 2001–2012

Moore¹,

Bocour²,

Tran

et al. 2018

Open Forum Infectious Diseases

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BackgroundHepatocellular carcinoma (HCC) is a complication of chronic hepatitis B and C virus (HBV and HCV) infection. New York City (NYC) has a high prevalence of HBV and HCV, and infected persons likely face increased mortality from HCC and other causes. We describe the mortality profile of NYC residents with HBV or HCV, emphasizing the contributions of HCC and HIV coinfection.Methods Two existing data sets were combined to examine all individuals diagnosed with HBV or HCV in NYC first reported to the Health Department during 2001–2012 and their HCC, HIV, and vital status. Logistic regression was used to calculate the odds of HCC diagnosis by viral hepatitis status, whereas Cox proportional hazard regression was used to estimate the hazard of death by HCC/HIV status.ResultsIn total, 120 952 and 127 933 individuals were diagnosed with HBV or HCV, respectively. HCV-infected individuals had 17% higher odds of HCC diagnosis than HBV-infected individuals and 3.2 times higher odds of HIV coinfection. Those with HCV were twice as likely to die during the study period (adjusted hazard ratio, 2.04; 95% confidence interval, 1.96–2.12). The risk of death increased for those with HIV or HCC and was highest for those with both conditions.ConclusionsHCC and HIV represent substantial risks to survival for both HBV- and HCV-infected individuals. Individuals with HBV need close monitoring and treatment, when indicated, and routine HCC screening. Those with HCV need increased, timely access to curative medications before developing liver disease.

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“…More recent estimates of viremic hepatitis C in the United States report a prevalence rate of 0.9%, or 2,936,000 . The largest proportion of patients with chronic HCV in the United States were born between 1945 and 1965, a pattern attributed to high rates of prior IDU in this age cohort. Prevalence in Northern and Western European countries is similar or slightly lower than in the United States, although there have been some recent increases attributed to immigration from countries where HCV is endemic.…”

Section: Predominant Genotypes By Regionmentioning

confidence: 99%

Epidemiology of Hepatitis C

Jafri

Gordon

2018

Clinical Liver Disease

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Long-Term Liver Disease, Treatment, and Mortality Outcomes Among 17,000 Persons Diagnosed with Chronic Hepatitis C Virus Infection

Cited by 21 publications

References 33 publications

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

Effect of Hepatocellular Carcinoma on Mortality Among Individuals With Hepatitis B or Hepatitis C Infection in New York City, 2001–2012

Epidemiology of Hepatitis C

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