Treatment of HCV reduces viral hepatitis-associated liver-related mortality in patients: An ERCHIVES study.
Treating hepatitis C virus (HCV) infection reduces overall mortality and reduces the risk of multiple extrahepatic complications. Whether the reduction in mortality is primarily due to reduction in liver-related causes or extrahepatic complications is unknown.We identified HCV+ persons treated for HCV, and propensity-score matched HCV+/untreated and HCV-uninfected persons in ERCHIVES between 2002-2016. We extracted cause of death data from the National Center for Health Statistics’ National Death Index. Viral hepatitis associated liver-related mortality rates among treated and untreated HCV-infected persons were calculated by treatment and attainment of sustained virologic response (SVR).Among 50,674 HCV+/treated (Group A), 31,749 HCV+/untreated (Group B) and 73,526 HCV-uninfected persons (Group C), 8.6% in Group A, 35.0% in Group B, and 14.3% in Group C died. Among those who died, viral hepatitis associated liver-related mortality rates per 100 patients years [95% CI] were: 0.28[0.27,0.30] for Group A; 1.44 [1.38,1.49] for Group B; and 0.06[0.05,0.06] for Group C; (P<0.0001 for both comparisons). Among HCV+/treated persons, rates were 0.06[0.05,0.06] for those with SVR vs. 0.78[0.74,0.83] for those without SVR. In competing risks Cox proportional hazards analysis, treatment with all-oral DAA regimens (adjusted hazard ratio 0.11[0.09,0.14] and SVR (adjusted hazard ratio 0.10[0.08, 0.11]) were associated with reduced hazards of liver-related mortality.Treatment for HCV is associated with a significant reduction in viral hepatitis associated liver-related mortality which is particularly pronounced in those treated with DAA regimens and those who attain SVR. This may account for a significant proportion of reduction in all-cause mortality reported in previous studies.