Saturday, January 1, 2011

Steady Hepatitis C mortality rates disappoint in Australia

Last Updated: 2010-12-31 17:52:24 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - In Australia in the past few years, death rates in patients with hepatitis C virus have not increased - but they haven't improved, either, researchers say.

"Although treatment strategies have improved over the past decade," Dr. Gregory J. Dore told Reuters Health by email, "stable rates of liver disease-related mortality among people with hepatitis C reflect low treatment uptake and poor treatment outcomes in the setting of advanced liver disease."

Dr. Dore of The University of New South Wales, Sydney and colleagues analyzed data from 1992 to 2006 on more than 42,000 people with hepatitis B monoinfection and roughly 82,000 with hep C monoinfection.

Compared to the general population there, the group with hepatitis B had a marginally elevated age- and sex adjusted overall mortality rate. But for hepatitis C patients, that rate was around two and half times higher than in the general public, the authors reported online December 9th n the Journal of Hepatology.

Over the study period, the hepatitis B group had a decrease in non-hepatoma deaths - but the hepatitis C group did not.

This finding in the hepatitis B group "suggests that even in the setting of relatively low antiviral therapy uptake, the potential use and improved potency of therapy in those with advanced liver disease is having an impact," Dr. Dore said.

The research team also found that HIV co-infection (present in 0.2% of the hepatitis B group and 0.5% of the hepatitis C group) increased overall mortality by 10-fold in hep B patients vs threefold in hep C patients.

Patients were at higher risk for liver-related death with hepatitis B (standardized mortality ratio 10.0) and hepatitis C (SIR 15.8) compared to the general population,

The hepatitis C group also had a higher risk for drug-related death (SMR 15.4). This group's drug-related mortality in 2002, however, was approximately half that in years prior to 2000, and rates have remained low since. This, say the investigators, is most likely due to the Australian heroin shortage in which both supply and purity decreased while the price increased markedly.

In fact, said Dr. Dore, "Among people with hepatitis C, liver disease has overtaken drug-related causes as the major contributor to mortality."

But, he concluded, "Improved antiviral therapy uptake and outcomes are required to reduce liver disease related mortality among people with hepatitis C."


J Hepatol 2010

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