Mortality rates among patients successfully treated for hepatitis C still higher than the general population

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1. Among those treated for Hepatitis C Virus (HCV) infection, leading causes of death included drug abuse, liver failure, and liver cancer, and all-cause mortality was higher for those treated for HCV compared to the general population. 

Evidence rating level: 2 (Good)

Interferon-free antiviral agents have changed the landscape of hepatitis C virus (HCV) infection since 2014. Compared to previous management options, current treatments are shorter in duration and more effective, leading to HCV cure in >95% of patients. In this population-based cohort study, researchers aimed to determine the mortality rates for patients successfully treated for HCV since 2014. The study included 21,790 participants who were treated for HCV between 2014 and 2019. Participants were classified into three groups: those without cirrhosis, those with compensated cirrhosis, and those with end-stage liver disease. The cohort was followed from 12 weeks after initiating antiviral treatment until December 31, 2019, or their death. 7% of participants died during the study period. The majority of deaths were due to drug-related causes (24%), liver failure (18%), and liver cancer (16%). All-cause mortality, in deaths per 1000 person-years, was 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively, which is much higher than the general population. Higher mortality rates were associated with age, substance abuse, and comorbidities. Although treatments for HCV infection have improved greatly in the past decade, this study emphasizes the need for follow-up care for infected individuals after completing antiviral therapy. Future research could examine whether coupling addiction counseling with antiviral treatment improves mortality rates associated with HCV infection. 

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