Mortality Higher in HCV Patients Without Other Significant Morbidities

All-cause, liver, and cardiac mortality is higher among hepatitis C virus (HCV)-seropositive individuals, without other significant comorbidities, compared with HCV-negative individuals. However, most HCV-positive, but otherwise healthy individuals, don't die of liver disease.

"Chronic HCV infection is neither a death sentence nor benign," Dr. Edward L. Murphy from University of California, San Francisco, told Reuters Health. "There is a very strong link to liver disease, but these account for only a minority of deaths among HCV infected persons. More attention needs to be paid to lifestyle and risk behaviors."

Dr. Murphy and colleagues investigated mortality rates among apparently healthy blood donors screened for HCV antibodies at the time of blood donation. Their findings appear in the March 15th issue of the American Journal of Epidemiology.

Overall mortality among HCV-positive donors was 3.13 times higher than that among matched HCV-negative donors, the authors report. HCV seropositivity was also strongly associated with drug/alcohol-related deaths, infectious deaths, liver-related deaths and less strongly with trauma/suicide-related deaths and cardiovascular deaths, the report indicates.

The standardized mortality ratio for the HCV-positive group relative to the US population mortality in 2000 was 2.13, whereas that for the HCV-negative group was 0.71.

"We were somewhat surprised to find an approximately threefold hazard ratio estimate for all-cause mortality," the investigators say. Some studies have suggested that rates of cirrhosis and hepatocellular cancer mortality in HCV-infected subjects have been overestimated.

For example, patients infected through blood transfusions may die from conditions that necessitated transfusion. The researcher had hypothesized that "HCV would not be associated with mortality in an initially healthy blood donor population."

"One message of the paper is that paying attention only to liver status may not be enough," Dr. Murphy said. "The higher rate of cardiovascular mortality suggests paying more attention to cardiovascular risk factors (cholesterol, hypertension, smoking, obesity)."

"In addition, the high rate of mortality related to substance abuse, trauma, and suicide suggests that physicians should screen for and treat substance abuse (including alcohol), psychological disease, and risk-taking behavior."

"We hope that the same kind of analysis can be replicated using other large blood donor databases, such as those maintained by the American Red Cross or in Scandinavia," Dr. Murphy added. "We had trouble getting this article published in our initial target journals: those read by practitioners who treat HCV."

"We wonder if the message of the study is one that some practicing hepatologists, who reviewed our manuscript, found difficult to accept."

Am J Epidemiol 2008;167:743-750