title: Little evidence that hepatitis C virus leads to a higher risk of mortality in the absence of cirrhosis and excess alcohol intake: the Swiss Hepatitis C Cohort Study.
abstract: The objective of this study was to describe the all-cause mortality of participants in the Swiss Hepatitis C Cohort compared to the Swiss general population. Patients with hepatitis C virus (HCV) infection attending secondary and tertiary care centres in Switzerland. One thousand six hundred and forty-five patients with HCV infection were followed up for a mean of over 2 years. We calculated all-cause standardized mortality ratios (SMR) and 95% confidence intervals (CI) using age, sex and calendar year-specific Swiss all-cause mortality rates. Multivariable Poisson regression was used to model the variability of SMR by cirrhotic status, HCV genotype, infection with hepatitis B virus or HIV, injection drug use and alcohol intake. Sixty-one deaths were recorded out of 1645 participants. The crude all-cause SMR was 4.5 (95% CI: 3.5-5.8). Patients co-infected with HIV had a crude SMR of 20 (95% CI: 11.1-36.1). The SMR of 1.1 (95% CI: 0.63-2.03) for patients who were not cirrhotic, not infected with HBV or HIV, did not inject drugs, were not heavy alcohol consumers (<or=40 g/day) and were not genotype 3, indicated no strong evidence of excess mortality. We found little evidence of excess mortality in hepatitis C infected patients who were not cirrhotic, in the absence of selected risk factors. Our findings emphasize the importance of providing appropriate preventive advice, such as counselling to avoid alcohol intake, in those infected with HCV.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. leoniep@doctors.org.uk
authors.forename: L
authors.initials: L
authors.lastname: Prasad
authors.forename: V M
authors.initials: VM
authors.lastname: Spicher
authors.forename: F
authors.initials: F
authors.lastname: Negro
authors.forename: M
authors.initials: M
authors.lastname: Rickenbach
authors.forename: M
authors.initials: M
authors.lastname: Zwahlen
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013557:Switzerland