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Sustained viral response improves patient survival with either
compensated or decompensated
hepatitis C
Bennet D. Cecil, MD
Mary Lavelle ARNP
Louisville VAMC
Background and aims We report the survival experience of our prospective cohort
of 312 American military veterans treated with antiviral therapy. We examine the
effect of sustained viral response (SVR) and other explanatory variables on
survival.
Methods: We treated 312 patients with HCV with antiviral therapy at the
Louisville VAMC between May 1998 and November 2004. 43 patients were lost to
follow up, leaving 269 for analysis. We compared the survival of the 74 patients
achieving SVR to the experience of 195 who did not achieve SVR. The mean
duration of observation was 3.9 years (range 0.3-6.5 years). We used multiple
logistic regression (Stata 8) to choose important explanatory variables for all
cause mortality.
Results: 3 of 74 (4%) patients with SVR died while 49 of 195 (25%) without SVR
died. 5 of 28 (18%) decompensated patients achieved SVR, and 4 (80%) are alive.
1 died from HCC. 20 of 23 (87%) decompensated patients without SVR died.
Multiple logistic regression indicated that decompensated liver disease, lack of
SVR and history of alcohol or drug abuse predicted mortality. LR chi2 (3) =
83.09 Prob > chi2 = 0.0000 Two of our patients received liver transplants, one
for HCC and one for decompensated liver disease. Both were nonresponders to
antiviral therapy.
Variable Odds Std. Err. Ratio z P>|z| [95% Conf. Interval]
Decomp 22.4 12.9 5.41 0.000 7.3 69.0
No SVR 9.4 6.8 3.14 0.002 2.3 38.4
Drug or alcohol abuse 5.4 2.5 3.71 0.000 2.2 13.3
Conclusions: Patients who achieved SVR demonstrated greatly improved survival in
this cohort of US military veterans. This survival benefit of SVR was
demonstrated in the cohort as a whole and in the subgroup of decompensated
patients. Successful antiviral therapy for HCV is a life saving intervention.
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