BOSTON – Risks for mortality, hepatocellular carcinoma, and liver transplantations were significantly lower in patients with hepatitis C who achieved a sustained virologic response after treatment, compared with patients without a sustained response, in a meta-analysis of long-term follow-up data on 23,309 patients.
In patients with a sustained virologic response (SVR), the risk of death was 62%-84% lower, the risk of developing hepatocellular carcinoma was 68%-79% lower, and the risk of liver transplantation was 90% lower, compared with patients who did not achieve a SVR, Andrew M. Hill, Ph.D., and his associates reported at the annual meeting of the American Association for the Study of Liver Diseases.
Andrew M. Hill, Ph.D.
The cohort included 15,067 patients with hepatitis C without cirrhosis, HIV, or prior transplantation; 4,987 patients with hepatitis C and cirrhosis; 1,170 patients with hepatitis C who had undergone liver transplantation; and 2,085 patients coinfected with hepatitis C and HIV.
Treatment consisted primarily of pegylated interferon plus ribavirin. “These analyses need to be repeated for studies of direct acting antivirals,” said Dr. Hill of the University of Liverpool, England.
In the current study, SVR was associated with a 62% reduction in the risk of death in the general group of mono-infected patients without cirrhosis or transplantation, an 84% reduction in patients with cirrhosis, and a 73% reduction in those coinfected with HIV, multivariate analyses showed.
The 5-year risk of all-cause mortality was 4.5% after SVR and 10.5% with no SVR in the general group of patients with HCV. In those with cirrhosis, mortality rates were 3.6% after SVR or 11.3% with no SVR. In patients who also had HIV, mortality rates were 1.3% after SVR and 10% with no SVR, Dr. Hill reported.
The 5-year risk of developing hepatocellular carcinoma as 2.9% after SVR and 9.3% with no SVR in the general group with HCV. In patients with cirrhosis, hepatocellular carcinoma rates were 5.3% with SVR and 13.9% with no SVR. In patients who had HIV, hepatocellular carcinoma rates were 0.9% after SVR and 10% with no SVR.
Reinfection with HCV can complicate the results of treatment, Dr. Hill said. The 5-year reinfection rates were 0.9% in low-risk patients, 8.2% in IV drug users or prisoners, and 23.6% in patients coinfected with HIV.
“The cost-effectiveness of treatment of hepatitis C depends on the extent of reductions in the risk of liver transplantation, hepatocellular carcinoma, and all-cause mortality,” he said.
The World Health Organization and UNITAID funded the study. Dr. Hill reported financial associations with Janssen Pharmaceuticals.