title: Excess liver-related morbidity of chronic hepatitis C patients, who achieve a sustained viral response, and are discharged from care.
abstract: Our objective was to address two shortfalls in the hepatitis C virus (HCV) literature: (1) Few data exist comparing post-treatment liver-related mortality/morbidity in HCV-sustained virologic response (SVR) patients to non-SVR patients and (2) no data exist examining liver-related morbidity among treatment response subgroups,particularly among noncirrhotic SVR patients, a group who in the main are discharged from care without further follow-up. A retrospective cohort of 1,215 previously naïve HCV interferon patients (treated 1996-2007)was derived using HCV clinical databases from nine Scottish clinics. Patients were followed up post-treatment for a mean of 5.3 years. (1) By Cox-regression, liver-related hospital episodes (adjusted hazard ratio [AHR]:0.22; 95% confidence interval [CI]: 0.15-0.34) and liver-related mortality [corrected] (AHR: 0.22; 95% CI: 0.09-0.58)were significantly lower in SVR patients, compared to non-SVR patients. (2) Rates of liver-related hospitalization were elevated among all treatment subgroups compared to the general population: Among noncirrhotic SVR patients, adjusted standardized morbidity ratio (SMBR) up to 5.9 (95% CI: 4.5-8.0); among all SVR patients,SMBR up to 10.5 (95% CI: 8.7-12.9); and among non-SVR patients, SMBR up to 53.2 (95% CI: 49.4-57.2).Considerable elevation was also noted among patients who have spontaneously resolved their HCV infection(a control group used to gauge the extent to which lifestyle factors, and not chronic HCV, can contribute toliver-related morbidity), SMBR up to 26.8 (95% CI: 25.3-28.3).
  
  
  CONCLUSIONS
  (1) Patients achieving an SVR were more than four times less likely to be hospitalized, or die for a liver-related reason, than non-SVR patients and (2) although discharged, noncirrhotic SVR patients harbor a disproportionate burden of liver-related morbidity; up to six times that of the general population. Further, alarming levels of liver-related morbidity in spontaneous resolvers is an important finding warranting further study..
authors: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, United Kingdom. Hamish.innes@nhs.net
authors: Hamish A
authors: HA
authors: Innes
authors: Sharon J
authors: SJ
authors: Hutchinson
authors: Samuel
authors: S
authors: Allen
authors: Diptendu
authors: D
authors: Bhattacharyya
authors: Peter
authors: P
authors: Bramley
authors: Toby E S
authors: TE
authors: Delahooke
authors: John F
authors: JF
authors: Dillon
authors: Ewan
authors: E
authors: Forrest
authors: Andrew
authors: A
authors: Fraser
authors: Ruth
authors: R
authors: Gillespie
authors: David J
authors: DJ
authors: Goldberg
authors: Nicholas
authors: N
authors: Kennedy
authors: Scott
authors: S
authors: McDonald
authors: Allan
authors: A
authors: McLeod
authors: Peter R
authors: PR
authors: Mills
authors: Judith
authors: J
authors: Morris
authors: Peter
authors: P
authors: Hayes
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D016208:Databases, Factual / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000401:mortality*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008108:Liver Diseases, Alcoholic / Q000401:mortality*; D008297:Male; D009017:Morbidity; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents