Monday, June 26, 2017

Changing trends in complications of chronic hepatitis C

Original Article
Changing trends in complications of chronic hepatitis C
Mei Lu, Jia Li, Loralee B. Rupp, Yueren Zhou, Scott D. Holmberg, Anne C. Moorman, Philip R. Spradling, Eyasu H. Teshale, Joseph A. Boscarino, Yihe G. Daida, Mark A. Schmidt, Sheri Trudeau, Stuart C. Gordon
Accepted manuscript online: 21 June 2017
DOI: 10.1111/liv.13501  

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Background and Aims
Chronic hepatitis C virus (HCV)-related complications have increased over the past decade.

We used join-point regression modeling to investigate trends in these complications from 2006–2015, and the impact of demographics on these trends. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we identified points at which the trend significantly changed, and estimated the annual percent change (APC) in rates of cirrhosis, decompensated cirrhosis, and all-cause mortality, adjusted by race, sex, and age.

Among 11,167 adults with chronic HCV infection, prevalence of cirrhosis increased from 20.8% to 27.6% from 2006 to 2015 with adjusted annual percentage change (aAPC) of 1.2 (p<0.01). Although incidence of all-cause mortality increased from 1.8% in 2006 to 2.9% in 2015, a join-point was identified at 2010, with aAPCs of 9.6 before (2006<2010; p<0.01) and -5.2 after (2010≤2015; p<0.01), indicating a decrease in mortality from 2010 and onward. Likewise, although overall prevalence of decompensated cirrhosis increased from 9.3% in 2006 to 10.4% in 2015, this increase was confined to patients 60 or older (aAPC=1.5; p=0.023). Asian American and Black/ African American patients demonstrated significantly higher rates of cirrhosis than White patients, while older patients and men demonstrated higher rates of cirrhosis and mortality.

Although cirrhosis and mortality among HCV-infected patients in the US have increased in the past decade, the mortality has decreased in recent years.
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Recommended Reading
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The effect of SVR on the risk of extrahepatic manifestations of HCV infection
Gut. 2017 Jun 20. pii: gutjnl-2017-313983. doi: 10.1136/gutjnl-2017-313983. [Epub ahead of print]
Compared with HCV-infected individuals who did not receive treatment, SVR attainment was associated with a reduced risk of mixed cryoglobulinaemia, glomerulonephritis, porphyria cutanea tarda, non-Hodgkin's lymphoma, diabetes mellitus and stroke, but not lichen planus or coronary heart disease. Risk reductions were also observed when patients with SVR were compared with treated patients without SVR for mixed cryoglobulinaemia, glomerulonephritis, porphyria cutanea tarda and diabetes.
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