title: Mortality in patients with chronic and cleared hepatitis C viral infection: a nationwide cohort study.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark. omland@dadlnet.dk
authors.forename: Lars Haukali
authors.initials: LH
authors.lastname: Omland
authors.forename: Henrik
authors.initials: H
authors.lastname: Krarup
authors.forename: Peter
authors.initials: P
authors.lastname: Jepsen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Georgsen
authors.forename: Lene Holm
authors.initials: LH
authors.lastname: Harritshøj
authors.forename: Kirsten
authors.initials: K
authors.lastname: Riisom
authors.forename: Svend Erik Hove
authors.initials: SE
authors.lastname: Jacobsen
authors.forename: Per
authors.initials: P
authors.lastname: Schouenborg
authors.forename: Peer Brehm
authors.initials: PB
authors.lastname: Christensen
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
mesh_terms: 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
chemical_list: D012367:RNA, Viral