1. Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders
- Author
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Cozen, Myrna L, Ryan, James C, Shen, Hui, Cheung, Ramsey, Kaplan, David E, Pocha, Christine, Brau, Norbert, Aytaman, Ayse, Schmidt, Warren N, Pedrosa, Marcos, Anand, Bhupinderjit S, Chang, Kyong-Mi, Morgan, Timothy, and Monto, Alexander
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Hepatitis ,Emerging Infectious Diseases ,Chronic Liver Disease and Cirrhosis ,Digestive Diseases ,Infectious Diseases ,Rare Diseases ,Substance Misuse ,Clinical Research ,Liver Disease ,Hepatitis - C ,Clinical Trials and Supportive Activities ,Cancer ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Infection ,Good Health and Well Being ,Adult ,Cohort Studies ,Female ,Hepatitis C ,Humans ,Interferon-alpha ,Liver Cirrhosis ,Male ,Middle Aged ,Proportional Hazards Models ,Ribavirin ,United States ,United States Department of Veterans Affairs ,Hepatitis C therapy ,Cirrhosis ,Hepatocellular carcinoma ,Survival ,Gastroenterology & Hepatology ,Clinical sciences - Abstract
BackgroundAs the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated.AimTo more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients.MethodsPatients with chronic HCV were prospectively enrolled in 1999-2000 from 11 VA medical centers and followed through retrospective medical record review.ResultsA total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46-0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up-factors typically associated with treatment eligibility.ConclusionsAs more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.
- Published
- 2016