Excess liver-related morbidity of chronic hepatitis C patients, who achieve a sustained viral response, and are discharged from care

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Abstract
Our aim was to address two shortfalls in the hepatitis C virus (HCV) literature: (1) Few data exist comparing post-treatment liver-related mortality/morbidity in HCV-sustained virologic response (SVR) patients to non-SVR patients and (2) no data exist examining liver-related morbidity among treatment response subgroups, particularly among noncirrhotic SVR patients, a group who, in the main, are discharged from care without further follow-up. A retrospective cohort of 1,215 previously naïve HCV interferon patients (treated 1996-2007) was derived using HCV clinical databases from nine Scottish clinics. Patients were followed up post-treatment for a mean of 5.3 years. (1) By Cox-regression, liver-related hospital episodes (adjusted hazard ratio [AHR]: 0.22; 95% confidence interval [CI]: 0.15-0.34) and LRM (AHR: 0.22; 95% CI: 0.09-0.58) were significantly lower in SVR patients, compared to non-SVR patients. (2) Rates of liver-related hospitalization were elevated among all treatment subgroups, compared to the general population: Among noncirrhotic SVR patients, adjusted standardized morbidity ratio (SMBR) was up to 5.9 (95% CI: 4.5-8.0); among all SVR patients, SMBR was up to 10.5 (95% CI 8.7-12.9); and among non-SVR patients, SMBR was up to 53.2 (95% CI: 49.4-57.2). Considerable elevation was also noted among patients who have spontaneously resolved their HCV infection (a control group used to gauge the extent to which lifestyle factors, and not chronic HCV, can contribute to liver-related morbidity), with SMBR up to 26.8 (95% CI: 25.3-28.3). Conclusions: (1) Patients achieving an SVR were more than four times less likely to be hospitalized, or die for a liver-related reason, than non-SVR patients and (2) although discharged, noncirrhotic SVR patients harbor a disproportionate burden of LRM (i.e., up to six times that of the general population). Furthermore, alarming levels of LRM in spontaneous resolvers is an important finding warranting further study. (Hepatology 2011;)