AASLD 2016 - Large Study Identifies Increase of Cirrhosis in Hepatitis C Patients

AASLD Additional Reading - Sustained SVR With Sofosbuvir-Based Regimens in Chronic HCV With Cirrhosis Confirmed
"Preliminary data from this ongoing observational study of SOF-treated patients with cirrhosis who have achieved SVR show SVR maintained in >99% of patients with a median follow-up of 21 months from the end of treatment," reported Andrew J. Muir, MD, of Duke University in Durham, NC.

Large Study Identifies Increase of Cirrhosis in Hepatitis C Patients

SOURCE American Association for the Study of Liver Diseases (AASLD)

BOSTON, Nov. 11, 2016 /PRNewswire/ -- Over the past decade, the prevalence of cirrhosis has increased by almost 40 percent among people with hepatitis C (HCV) in the United States, according to research presented at The Liver Meeting® - held by the American Association for the Study of Liver Diseases.

Hepatitis C has been linked to cirrhosis (i.e., scarring of the liver), decompensated cirrhosis, and death, but the extent of the prevalence of these conditions among hepatitis C patients in the U.S. has not yet been observed in large real-world studies within the U.S. Researchers recently sought to fill this research gap by studying the prevalence of cirrhosis and decompensated cirrhosis - as well as the incidence of death - among 11,169 U.S. adults between 2006 and 2014.

"This analysis of cirrhosis prevalence is part of a larger study of viral hepatitis in the U.S., called the Chronic Hepatitis Cohort Study or 'CHeCS'," explains Stuart C. Gordon, MD; director of Hepatology, Department of Gastroenterology and Hepatology, Henry Ford Health System and one of the lead investigators in the study. "Based at Henry Ford Health System in Detroit, we work in concert with three other U.S. health systems and the Centers for Disease Control to study the outcomes and treatments for hepatitis B and C in 'real world' patients, i.e., those under routine clinical care. Previous estimates had suggested that the medical burden of chronic hepatitis C and its complications would increase in the U.S. given the aging of the population, including the "baby boomer" cohort born between 1945 and 1965 who are at the highest risk for infection. We attempted to a) gauge whether, in fact, HCV related cirrhosis and its complications were increasing and b) if so, whether there were disparities among different populations in order to better target for treatment those groups that may be at higher risk of poor outcomes."

The patients studied were receiving care at the four large U.S. healthcare systems that participate in the CHeCS study. The investigators identified cirrhosis using liver biopsy reports, serum markers of liver scarring, and ICD-9 diagnostic codes. The team also used a set of ICD-9 codes that have been shown to predict decompensated cirrhosis - the term used when cirrhosis becomes so severe that the liver ceases to function properly - to determine its presence in patients.

Once patients with cirrhosis were identified, the researchers looked at the annual percentage change between several different points in time to identify trends. They observed that the prevalence of cirrhosis among HCV patients increased from 20.5 percent in 2006 to 28.5 percent in 2014, with the steepest increase occurring from 2006-2007. Prevalence of decompensated cirrhosis varied by patients' age; it increased by roughly two percent per year over the study period in the oldest patients (those over 60), but largely stayed the same among younger patients. Finally, deaths in this group of patients nearly doubled from 1.7 percent in 2006 to 3.2 percent in 2013, but most of this increase took place prior to 2010, after which the rate of deaths leveled off.

"The proportion of hepatitis C patients with cirrhosis and its complications has grown significantly in the past decade, particularly among those over 60," says Dr. Gordon. The present analysis confirms the rising burden of chronic hepatitis C infection, and its complications, on the U.S. health care system. These rising rates may have leveled off in recent years, however, possibly related to better options for treating HCV infection. Future studies will help determine whether increased uptake of these newer medications can help stem the tide of HCV disease progression."

This release reflects updated data provided by the investigators of the study. The study entitled "Hepatitis C Complications: Prevalence and Disparities in a Large US Cohort 2006-2014" will be presented by Mei Lu, PhD on Monday, November 14 at 11:15am at the Sheraton Back Bay Room ABC. The corresponding abstract (number 180) can be found in the journal, Hepatology – Special Issue: The 67th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2016.