Effect of hepatitis C virus and its treatment on survival†‡

Abstract

The effect of hepatitis C virus (HCV) and its treatment on survival is not well defined. We undertook this study to determine the effect of HCV and its treatment on survival in a national cohort of HCV-infected veterans and uninfected controls. We used a national sample of HCV-infected persons and HCV-uninfected controls from the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) to compare survival between the two groups. We also compared the effect of treatment and treatment duration on survival in the HCV-infected group. We used matched Cox proportional hazards model to determine the predictors of mortality. Kaplan-Meier survival plots were generated to determine and compare survival among HCV-infected and HCV-uninfected persons, and among treated and untreated HCV-infected persons.We identified 34,480 matched pairs of HCV-infected subjects and controls. HCV infection was independently associated with a higher risk of mortality (hazards ratio, 1.37; 95% confidence interval, 1.31-1.47). Subjects treated for 48 weeks or longer had the lowest mortality among HCV-infected subjects (hazards ratio, 0.41; 95% confidence interval, 0.27-0.64), whereas those who received less than 48 week of treatment had intermediate mortality (hazards ratio, 0.71 and 0.60 for 0-23 weeks and 24-47 weeks of treatment, respectively) compared with untreated subjects. Conclusion: HCV infection is associated with a substantial increase in mortality. Subjects who are initiated on treatment, and particularly those who proceed to finish a full course of treatment, have significantly reduced risk of mortality. Further studies are warranted to determine the effect of virological control on survival. (HEPATOLOGY 2009.)