Researchers find how people with hepatitis C cure still face risk of death

Washington [US], August 3 (ANI): Even after being cured of their hepatitis C infection, those who have recovered still have a far higher chance of dying than the general population—between three and fourteen times higher, depending on the severity of their liver illness.
The findings of the study were published by The BMJ.
Drawing from a database of over 20,000 individuals who have achieved a hepatitis C cure, the findings indicate that drug- and liver-related causes of death accounted for the majority of excess fatalities. This underscores the necessity of sustained assistance in order to fully reap the rewards of a hepatitis C cure.
The virus known as hepatitis C can infect the liver and, over several years, if treatment is not received, can result in significant and potentially fatal liver damage.
Historically, hepatitis C was treated with interferon-based therapy, which was often ineffective. But in 2011, new medications called direct acting antivirals (DAA) were developed. Now more than 95% of patients treated with DAAs achieve a “virological cure” and have a significantly lower risk of death than untreated patients.
Yet the question of what prognosis cured patients can expect compared with the general population remains the subject of debate.
To explore this further, a team of UK and Canadian researchers set out to measure mortality rates in individuals with a hepatitis C cure and assess how these rates compare with the general population.
They analysed data from three population studies carried out in British Columbia (Canada), Scotland and England involving 21,790 individuals who achieved a hepatitis C cure between 2014 and 2019. 
Individuals were grouped by the severity of liver disease at the time of cure: pre-cirrhosis (British Columbia and Scotland studies only), compensated cirrhosis, and end stage liver disease.
Data were then linked to national medical registries and several causes of death were examined, including liver cancer, liver failure, drug-related death, external causes (mainly accidents, homicides and suicides) and diseases of the circulatory system, over an average follow-up period of 2-4 years.
Most participants did not have cirrhosis at cure. The average age of pre-cirrhosis patients in Scotland was 44 years and 56 years in British Columbia, and males outnumbered females across all studies and disease severity groups (65-75%). 
A total of 1,572 (7%) of participants died during follow-up. The leading causes of death were drug related (24 per cent), liver failure (18 per cent) and liver cancer (16 per cent). 
After taking account of age, death rates were considerably higher than the general population across all disease severity groups and settings. 
For example, in Scotland, the rate for all patients was 4.5 times greater than the general population (442 deaths observed versus 98 expected), while in British Columbia, rates were 3.9 times greater (821 deaths observed versus 209 expected). 
Rates also increased appreciably with liver disease severity. For example, in British Columbia rates were 3 times higher in people without cirrhosis and 14 times higher for patients with end stage liver disease.
For patients without cirrhosis, the leading cause of excess death was drug related, whereas in patients with cirrhosis, the two leading drivers were liver cancer and liver failure.
Across all disease stages and settings, older age, recent substance use, alcohol use and pre-existing conditions (comorbidities) were associated with higher death rates.
These are observational findings and the researchers acknowledge that they may not apply to all settings, particularly where injecting drug use is not the dominant mode of hepatitis C transmission. (ANI)