1. Hepatitis C Patients With Undetectable Hepatitis C Virus (HCV) RNA Had Reduced Liver Disease Burden Compared To Patients With Detectable Levels
2. Patients with undetectable HCV RNA also had a significantly reduced risk of all-cause death.
Evidence Rating Level: 2 (Good)
Study overview: Hepatitis C is a major contributor to the liver disease burden for drug injectors (PWID), associated with high morbidity and mortality. Since the availability of direct-acting antiviral treatments for HCV in 2015, levels of viraemia in people with hepatitis C infections have decreased. In the current study, patients with undetected HCV had significantly lower levels of liver stiffness (LSM) than patients with detectable HCV RNA, a marker of liver disease severity. Undetectable levels of HCV RNA were also associated with a significantly reduced risk of developing liver cirrhosis. Other risk factors associated with a higher risk of cirrhosis were baseline age, body mass index, number of co-morbidities and human immunodeficiency virus (HIV) co-infection. The risk of all-cause death was significantly lower in patients with undetectable HCV RNA compared to those with detectable HCV RNA. A limitation of this study is that HCV treatment uptake may be higher in populations more motivated to maintain good health, thereby biasing the study population, which could lead to lower mortality estimates.
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Relevant Literature: Restrictions on Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States
in-depth [prospective cohort]: The ALiVE (AIDS Linked to the IntraVenous Experience) study followed a community-recruited cohort of former and current PWID living in or near Baltimore. This study assessed the relationship between HCV treatments accessible to PWID, liver disease burden, and mortality. Of 1,323 participants, the median age was 49 years (interquartile range, 44 to 54 years). Most participants were black (82%), male (71%) and HIV negative (66%). Of the overall study population, 15% was observed to have an LSM indicative of cirrhosis at the baseline study visit (>=12.3 kPa). In the multivariate model, undetectable HCV RNA was associated with a decreased mean log LSM (95% confidence interval [CI], -0.181 to -0.115 kPa; p<0.001). Undetectable HCV RNA was also associated with a 72% reduction in the risk of cirrhosis at control for other covariates (adjusted odds ratio 0.28; 95% CI 0.17 to 0.45; p < 0.001). Furthermore, the risk of all-cause mortality was significantly lower in those who had undetectable HCV RNA than those who did not (adjusted hazard ratio 0.54; 95% CI 0.38 to 0.77; p < 0.001). The relationship was strengthened when only deaths not related to drugs or trauma were included in the analyses. In summary, the current study supports community-based hepatitis C treatment for PWID for reducing cirrhosis and mortality. Further collection of larger sets of population-based data can help inform adherence and success predictors.
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