The effectiveness of hepatitis C virus (HCV) treatment with pegylated interferon and ribavirin usually is evaluated by the surrogate end point of sustained virologic response, although the ultimate goal of antiviral treatment is to reduce mortality.
The impact of sustained virologic response on all-cause mortality is not well documented by HCV genotype or in populations in routine medical practice with substantial comorbidities.
From the US Department of Veterans Affairs, Dr Lisa Backus and colleagues from California, USA identified all patients infected with HCV genotypes 1, 2, or 3, without human immunodeficiency virus co-infection or hepatocellular carcinoma before HCV treatment with pegylated interferon and ribavirin.
Patients who started HCV treatment from 2001 to 2007 stopped treatment by 2008, and had a posttreatment HCV RNA test result of sustained virologic response or no sustained virologic response.
Mortality data from Veterans Affairs and non-Veterans Affairs sources were available through 2009.
HCV genotypes 1, 2, or 3 cohorts consisted of 12,166, 2904, and 1794 patients, respectively, with sustained virologic response rates of 35%, 72%, and 62%, respectively.
The research team reported that each cohort had high rates of comorbidities.
The team observed that during a median follow-up period of approximately 4 years, 1119 genotype-1, 220 genotype-2, and 196 genotype-3 patients died.
In genotype-specific multivariate survival models that controlled for demographic factors, comorbidities, laboratory characteristics, and treatment characteristics, the team found that a sustained virologic response was associated with substantially reduced mortality risk for each genotype.
Dr Backus' team concluded, "An sustained virologic response reduced mortality among patients infected with HCV of genotypes 1, 2, or 3 who were being treated by routine medical practice and had substantial comorbidities."
Clin Gastroenterol Hepatol 2011: 9(6): 509-516
02 June 2011
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