Excess Mortality Risk Among Hepatitis C Patients After Being “Cured” in The Interferon-Free Era: Results From Three Population-Based Cohorts

Author: Victoria Hamill Stanley Wong Jennifer Benselin M Krajden PC Hayes D Mutimer Amanda Yu JF Dillon Will Gelson HA Velásquez García P Johnson ST Barclay Will M Alvarez H Toyoda Kosh Agarwal Andrew Fraser Sophia Bartlett Mark Aldersely A Bathgate M Binka P Richardson JR Morling SD Ryder Douglas MacDonald Sharon Hutchinson Eleanor Barnes NI Guha WL Irving NZ Janjua Hamish Innes

Theme: Epidemiology & Public Health Research Year: 2022

Although the number of people living with a hepatitis C sustained viral response (SVR) has increased
dramatically, mortality rates in this patient group remain poorly understood. Our goal was to assess
excess mortality after SVR achievement in the interferon-free era.
We performed data analysis on patients achieving SVR in the interferon-free era (≥2014) from three
population-based cohorts in Scotland, England, and British Columbia (BC). Patients were divided into
three disease stage groups: no cirrhosis; compensated cirrhosis, and end stage liver disease (ESLD).
We calculated the standardised mortality ratio (SMR) to compare the frequency of mortality in SVR
patients to the general population. We also quantified the proportion of excess death attributable
to: a) death from liver cancer; b) death from liver disease unrelated to cancer; and c) death from
drug-related causes. Finally, Poisson regression was used to identify factors associated with excess
Our analysis included 20,031 patients, of which 1402 (7%) died during follow-up. The mean followup duration was 2.2-3.9 years, and the mean age ranged from 46.3 (Scotland) to 56.7 years old (BC).
SMRs indicated that all-cause mortality was 3.4-3.5 times higher than the general population in noncirrhosis patients, 4.2-5.9 times higher in compensated cirrhosis patients, and 8.7-15.3 times higher
in ESLD patients. For non-cirrhosis patients, drug-related causes were responsible for the greatest
proportion of excess death (77% Scotland; 41% BC). Conversely, for cirrhosis patients, liver-related
causes were the key driver, responsible for 30-95% of excess deaths (see Figure). In the regression
analysis, younger age, drug use and comorbidities were associated with greater excess mortality.
In the largest study performed to-date, we show that individuals achieving SVR in the interferon-free
era have a considerably higher mortality risk than the GP, driven mainly by drug-related mortality (in
non-cirrhosis patients) and liver-related causes (in cirrhosis patients).
Disclosure of Interest Statement: 
The conference collaborators recognise the considerable contribution that industry partners make to
professional and research activities. We also recognise the need for transparency of disclosure of
potential conflicts of interest by acknowledging these relationships in publications and presentations.

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