Abstract
BackgroundHepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. This study aimed to evaluate the impact of HCV infection on all-cause, liver-related, and non-liver-related mortality in a population living in an area with a high prevalence of HCV infection before the advent of Direct-Acting Antiviral (DAA) therapies, and to identify factors associated with cause-specific mortality among HCV-infected individuals.MethodsWe conducted a cohort study on 4492 individuals enrolled between 2003 and 2006 in a population-based seroprevalence survey on viral hepatitis infections in the province of Naples, southern Italy. Study participants provided serum for antibodies to HCV (anti-HCV) and HCV RNA testing. Information on vital status to December 2017 and cause of death were retrieved through record-linkage with the mortality database. Hazard ratios (HRs) for cause-specific mortality and 95% confidence intervals (CIs) were estimated using Fine-Grey regression models.ResultsOut of 626 deceased people, 20 (3.2%) died from non-natural causes, 56 (8.9%) from liver-related conditions, 550 (87.9%) from non-liver-related causes. Anti-HCV positive people were at higher risk of death from all causes (HR = 1.38, 95% CI: 1.12–1.70) and liver-related causes (HR = 5.90, 95% CI: 3.00–11.59) than anti-HCV negative ones. Individuals with chronic HCV infection reported an elevated risk of death due to liver-related conditions (HR = 6.61, 95% CI: 3.29–13.27) and to any cause (HR = 1.51, 95% CI: 1.18–1.94). The death risk of anti-HCV seropositive people with negative HCV RNA was similar to that of anti-HCV seronegative ones. Among anti-HCV positive people, liver-related mortality was associated with a high FIB-4 index score (HR = 39.96, 95% CI: 4.73–337.54).ConclusionsThese findings show the detrimental impact of HCV infection on all-cause mortality and, particularly, liver-related mortality. This effect emerged among individuals with chronic infection while those with cleared infection had the same risk of uninfected ones. These results underline the need to identify through screening all people with chronic HCV infection notably in areas with a high prevalence of HCV infection, and promptly provide them with DAAs treatment to achieve progressive HCV elimination and reduce HCV-related mortality.
Highlights
Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality
Among people infected with HCV, between 55 and 85% will progress to chronic HCV infection, a condition that puts them at risk of liver cirrhosis, liver failure, and hepatocellular carcinoma (HCC)
According to data from the United States population showing that diabetes and chronic renal disease were associated with an elevated risk of death in persons with chronic HCV infection [17], we identified individuals with hyperglycaemia and individuals with a reduced renal function
Summary
Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. A considerable number of data suggest that the use of Direct-Acting Antiviral (DAAs) therapies -with up to 95% rates of sustained virological response in patients, including those previously excluded from interferon-based regimenscould reverse the rising trends in HCV incidence and HCV-related morbidity and mortality [5,6,7]. To this regard, it is worth mentioning that the World Health Organization (WHO) targets for 2015–2030 include the reduction of new HCV infections by 80%, HCV deaths by 65%, increasing HCV diagnoses to 90% and the number of eligible persons who receive HCV treatment up to 80% [8]
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