Mortality in patients with chronic and cleared hepatitis C viral infection: a nationwide cohort study.
OBJECTIVE
It is unknown whether mortality differs between patients with chronic hepatitis C virus (HCV) replication and those who cleared the virus after infection. We examined the impact of chronic HCV replication on mortality among Danish patients testing positive for HCV antibodies.


METHODS
This nationwide cohort study focused on Danish patients with at least one HCV RNA measurement available after testing positive for HCV antibodies between 1996 and 2005. To capture long-term prognosis, eligible patients needed to be alive 1year after HCV RNA assessment. We estimated mortality rate ratios (MRRs) using Cox regression (for overall mortality) and subdistribution hazard ratios (SDHRs) for cause-specific mortality, controlling for gender, age, comorbidity, calendar period, alcohol abuse, injection drug use, and income.


RESULTS
Of the 6292 patients under study, 63% had chronic HCV-infection and 37% had cleared the virus. Five-year survival was 86% (95% confidence interval (CI): 84-87%) in the chronic HCV group and 92% (95% CI: 91-94%) in the cleared HCV group. Chronic HCV-infection was associated with higher overall mortality (MRR: 1.55, 95% CI: 1.28-1.86) and liver-related death (SDHR: 2.42, 95% CI: 1.51-3.88). Chronic HCV-infection greatly increased the risk of death from primary liver cancer (SDHR: 16.47, 95% CI: 2.24-121.00).


CONCLUSIONS
Patients with chronic HCV-infection are at higher risk of death than patients who cleared the infection. The substantial association found between chronic HCV-infection and death from primary liver cancer supports early initiation of antiviral treatment in chronically HCV-infected patients.
Omland
Lars Haukali
LH
Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark. omland@dadlnet.dk
Krarup
Henrik
H
Jepsen
Peter
P
Georgsen
Jørgen
J
Harritshøj
Lene Holm
LH
Riisom
Kirsten
K
Jacobsen
Svend Erik Hove
SE
Schouenborg
Per
P
Christensen
Peer Brehm
PB
Sørensen
Henrik Toft
HT
Obel
Niels
N
D000328:Adult; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D016174:Hepacivirus / Q000502:physiology; D006526:Hepatitis C / Q000401:mortality* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000401:mortality* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D014779:Virus Replication
D012367:RNA, Viral