Burden of HCV-induced cirrhosis expected to shift from men to women

Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.

While men still have a higher prevalence of conditions such as cirrhosis, investigators expect to see a shift in the burden of care as women with HCV complications outlive men with similar diagnoses.

“The current and near-term burden in HCV-related cirrhosis was disproportionately attributed to men,” according to Jennifer Kramer, PhD, investigator at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston. “However, the trends are expected to change after 2020.”

The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.

Investigators found annual average prevalence change (AAPC) among men and women was 13.1% and 15.2%, respectively, for cirrhosis, while overall mortality was 28.7% for men, compared with 15.5% for women (J Viral Hepat. 2017 Aug 16. doi: 10.1111/jvh.12728).

Dr. Kramer and her fellow investigators also found similar rates among decompensated cirrhosis between 15.6% and 16.9% for women and men, respectively, and hepatocellular cancer, 21% and 25.3%, respectively.

Women included in the cohort were, on average, younger (48 years vs. 53 years), were less likely to use alcohol (33% vs. 45%), and were less likely to have contracted diabetes (30% vs. 39%).

While men’s prevalence growth was equal to women’s, male patients are 1.7 times more likely to be infected with HCV (J Hepatol. 2012 Jun 2 doi: 10.1016/j.jhep.2012.05.018), which is reflected in overall incidence rates of complications.

As expected, overall incidence of cirrhosis was higher in men than in women, with incidence rates for men at 28.2% compared with 20.1% of women.

Similar differences were found in rates of decompensated cirrhosis, 18.6% in men compared with 12.4% in women, and hepatocellular cancer, 5.3% in men compared with 1.5% in women.

Shifting trends in burden of care toward women have investigators worried about current HCV treatment practices for female patients.

“The increasing burden of HCV complications in women is concerning,” the researchers wrote. “Studies show that women are less likely to receive antiviral treatment than men.”

Contrary to this claim, antiviral treatment rates among men and women in this study were almost identical: 23.6% of women and 23.3% of men.

While the difference in treatment is not evident, the low rate of treatment for both men and women is another concern for Dr. Kramer and her colleagues.

“In the U.S., HCV infection remains undiagnosed in over 50% of all persons with HCV disease,” the investigators wrote. “Access to highly affective yet expensive direct acting antiviral treatment remains a challenge.”

Findings from this study may not be a true representation of the U.S. HCV-infected population because patients were veterans, with differences such as a higher rate of alcohol use among women.

The researchers reported no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets