email Dr. Cecil

Hepatitis C does not reduce survival unless the patient has stage 3 (severe or bridging fibrosis) or cirrhosis

(stage 4 fibrosis). Patients with stage 0,1 and 2 fibrosis have normal survival There is a low risk of

fatal side effects from antiviral therapy. Rarely, a patient becomes severely depressed and

commits suicide. Patients have a higher risk of pneumonia, cellulitis (skin infections) and urinary tract

infections while on antiviral therapy. Rarely, these infections are fatal. A patient with mild liver damage

from HCV must weigh the risk of antiviral therapy and the benefits of curing the virus. If HCV is cured,

the liver damage stops progressing and usually will greatly improve. Patients with mild liver damage and

younger patients are more often successful with antiviral therapy than are those with stage 3 or 4 fibrosis

and middle aged or elderly patients.

Look at figure 3 below. It compares how Americans died in 1900, 1950 and 2002. In 1900, about 20% of

Americans died before age 5. Now 80% of Americans are live to at least 70. Half of us live to age 82 or

longer. We are mortal and very few live to be 100.

Look at the life table below from 2002. Look at the second column that shows the death rate each year.

The death rate does not go above one percent per year until age 61-62.

Look at the death rate for age 79-80 and see that it is about 5% per year. This brings home the accelerated

mortality of HCV cirrhosis. Patients are middle aged but die at the same speed as someone who is 79-80.

We looked at the survival of patients with hepatitis C, and I reported the results to

EASL April  14, 2005 in Paris. Patients with HCV who achieved  sustained virologic

 response had much better survival than those who were not successfully treated.

3 of 74 (4%) patients with SVR died while 49 of 195 (25%) without SVR died.

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.