JID: 'Chronic Hepatitis C Virus Infection Increases Mortality From Hepatic and Extrahepatic Diseases: A Community-Based Long-Term Prospective Study'

I reference this study entitled 'Chronic Hepatitis C Virus Infection Increases
Mortality From Hepatic and Extrahepatic Diseases: A Community-Based Long-Term
Prospective Study' from the "Journal of Infectious Diseases" all the time in conversation and seem to get a good discussion going. I'm hoping for the same outcome on the Internet, thus this post. This is a HUGE cohort study from China (n = 23,820). Grant it, the 'n' representative of the HCV seropositive population is rather small (1095) compared to the seronegative population (19,636), and the population is of Eastern descent, but even given the sampling and ethnic disparity, there are compelling conclusions here which bear further study. Most notably, that having replicating Hepatitis C virus results in not only greater hepatic-related mortality, but extra-hepatic as well. Replicating virus = inflammation of all types. This gives compelling fuel to treatment advocates arguments that, barring contraindications and other special cases, Hepatitis C-positive patients should be considered for treatment now vs 'warehousing' for drugs that might/might not make it to market in the future. Hopefully further prospective and retrospective data based on the conclusions here will shed more light on this controversial subject. 

JID: Chronic Hepatitis C Virus Infection Increases Mortality From Hepatic and Extrahepatic Diseases: A Community-Based Long-Term Prospective Study

JID article (can be DL'd here) looking at  the mortality rate of subjects who were HCV seropositive vs seronegative in a very large cohort. It suggests that any amount of replicating virus contributed to mortality from both hepatic and extrahepatic diseases, even if there was no liver damage present. My own takeaway here is HCV should be treated with the urgency granted to other viral diseases. The strategy of waiting two years for HCV- drugs that may/may not arrive to treat patients with replicating virus and no contraindications may not be the best way to go. Many thanks to Dr. Luber for the heads up on this study. 

Chronic Hepatitis C Virus Infection Increases Mortality From Hepatic and Extrahepatic
Diseases: A Community-Based Long-Term Prospective Study

Mei-Hsuan Lee,1 Hwai-I. Yang,1,2,3 Sheng-Nan Lu,4 Chin-Lan Jen,1 San-Lin You,1 Li-Yu Wang,5 Chih-Hao Wang,6 Wei J. Chen,7 Chien-Jen Chen,1,7 and for the R.E.V.E.A.L.-HCV Study Groupa
1Genomics Research Center, Academia Sinica, Taipei; 2Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung; 3Graduate Institute of Clinical Medical Science, China Medical University, Taichung; 4Department of Gastroenterology, Kaohsiung Chang-Gung
Memorial Hospital, Kaohsiung; 5MacKay Medical College, Taipei; 6Department of Cardiology, Cardinal Tien Hospital, Taipei; and 7Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan

Background. 
The study aimed to evaluate the risk of hepatitis C virus (HCV) infection on hepatic and extrahepatic
deaths. Methods. A cohort of 23 820 adults aged 30–65 years old were enrolled during 1991–1992. The seromarkers hepatitis B surface antigen (HBsAg), anti-HCV, and serum HCV RNA levels at study entry were tested. The vital status was ascertained through computerized linkage with national death certification profiles from 1991 to 2008.

Results.
There were 19,636 HBsAg-seronegatives, including 18 541 anti-HCV seronegatives and 1095 anti-
HCV seropositives. Among anti-HCV seropositives, 69.4% had detectable serum HCV RNA levels. There were 2394 deaths that occurred during an average follow-up period of 16.2 years. Compared with anti-HCV seronegatives, anti-HCV seropositives had higher mortality from both hepatic and extrahepatic diseases, showing multivariate-adjusted hazard ratio (95% confidence interval) of 1.89 (1.66–2.15) for all causes of death; 12.48 (9.34–16.66) for hepatic diseases; 1.35 (1.15–1.57) for extrahepatic diseases; 1.50 (1.10–2.03) for circulatory diseases; 2.77 (1.49–5.15) for nephritis, nephrotic syndrome, and nephrosis; 4.08 (1.38–12.08) for esophageal cancer; 4.19 (1.18–
14.94) for prostate cancer; and 8.22 (1.36–49.66) for thyroid cancer. Anti-HCV seropositives with detectable HCV RNA levels had significantly higher mortality from hepatic and extrahepatic diseases than anti-HCV seropositives with undetectable HCV RNA.

Conclusions.
Monitoring HCV RNA in anti-HCV seropositives is essential for the prediction of mortality
associated with hepatitis C.