Advancing Health Scientist and Executive Director of Data and Analytic Services at B.C. Centre for Disease Control (BCCDC), Dr. Naveed Janjua (Canadian lead) and his BCCDC colleague Dr. Sofia Bartlett, along with a team of researchers from Canada and the U.K., have made a significant observation pertaining to individuals who have been successfully cured of hepatitis C (HCV) infection. The study, which is the largest and most representative of its kind to date, reveals that despite there being a cure for HCV, treated individuals still face a significantly higher risk of death compared to the general population.
HCV is a serious liver infection that can lead to life-threatening liver damage, including cirrhosis, if not treated. Thankfully, since the introduction of second generation direct-acting antivirals (DAAs) in 2013, over 95% of HCV patients treated with these drugs have been cured, greatly reducing their risk of death compared to untreated patients. However, this new study answers questions about the prognosis of cured patients compared to the general population.
Death rates up to 14 times higher than the general population
The study, which analyzed over 20,000 patients with a hepatitis C cure throughout B.C., Scotland, and England, showed that cured patients had significantly higher death rates than the general population in all three study locations. This analysis was even consistent for patients without cirrhosis at the time of successful treatment. Patients with more advanced liver disease at the time of cure faced the highest mortality rates. In B.C., for example, patients with end-stage liver disease faced a mortality rate 13 times higher than the general population, while those without cirrhosis experienced a three times higher mortality rate.
The researchers identified several risk factors associated with higher death rates among cured patients, including older age, recent substance use, alcohol use, and pre-existing medical conditions.
Dr. Naveed Janjua
Dr. Janjua shared, “These results are really important because most observational studies before this have focused on the benefits of an HCV cure. They compare the lower mortality risk with untreated patients and those in whom treatment has failed,” he explained. “This new data comes from larger, more representative cohorts encompassing patients with a broad spectrum of disease severity. It can help us form a better picture of the prognosis for people who have been successfully treated for HCV. A group that will continue to grow as we strive to eliminate HCV.”
The study revealed that the leading causes of death in participants with cirrhosis at time of cure were liver cancer and liver failure, accounting for up to 80 per cent of excess deaths. For patients without cirrhosis, drug-related causes were the leading contributors, accounting for 44 per cent of excess deaths.
Findings highlight importance of ongoing post-cure support
The findings underscore the importance of ongoing support and follow-up care for individuals who have been cured of hepatitis C. The researchers highlight the importance of establishing robust care and harm reduction pathways after successful HCV treatment. “As we move towards HCV elimination, treatment programs must strike the right balance by combining HCV treatment with wider intervention and wraparound services,” explained Dr. Sofia Bartlett, “For example, some patients need more support to reduce drug and alcohol misuse after HCV cure, while those with cirrhosis who have received successful HCV treatment benefit from liver cancer surveillance. By doing so, we can fully harness the benefits of the hepatitis C cure and reduce the substantial mortality rates observed among cured patients.”
Although these findings are based on observational data and may not apply to all settings, the study stands as the largest and most representative of its kind to date. The researchers say their results “show unequivocally that cured patients continue to face substantial mortality rates, driven by liver and drug-related causes.”
Read the full study here.