British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
British Columbia Centre for Disease Control, Vancouver, BC, Canada.
J Hepatol. 2021 Nov;75(5):1049-1057. doi: 10.1016/j.jhep.2021.05.028. Epub 2021 Jun 25.
BACKGROUND & AIMS: We evaluated the effect of direct-acting antiviral (DAA)-induced sustained virologic response (SVR) on all-cause, liver- and drug-related mortality in a population-based cohort in British Columbia, Canada.
We used data from the British Columbia Hepatitis Testers Cohort, which includes people tested for HCV since 1990, linked with data on medical visits, hospitalizations, prescription drugs and mortality. We followed people who received DAAs and people who did not receive any HCV treatment to death or December 31, 2019. We used inverse probability of treatment weighting to balance the baseline profile of treated and untreated individuals and performed multivariable proportional hazard modelling to assess the effect of DAAs on mortality.
Our cohort comprised 10,851 people treated with DAAs (SVR 10,426 [96%], no-SVR: 425) and 10,851 matched untreated individuals. Median follow-up time was 2.2 years (IQR 1.3-3.6; maximum 6.2). The all-cause mortality rate was 19.5/1,000 person-years (PY) among the SVR group (deaths = 552), 86.5/1,000 PY among the no-SVR group (deaths = 96), and 99.2/1,000 PY among the untreated group (deaths = 2,133). In the multivariable model, SVR was associated with significant reduction in all-cause (adjusted hazard ratio [aHR] 0.19; 95% CI 0.17-0.21), liver- (adjusted subdistribution HR [asHR] 0.22, 95% CI 0.18-0.27) and drug-related mortality (asHR 0.26, 95% CI 0.21-0.32) compared to no-treatment. Older age and cirrhosis were associated with higher risk of liver-related mortality while younger age, injection drug use (IDU), problematic alcohol use and HIV/HBV co-infections were associated with a higher risk of drug-related mortality.
DAA treatment is associated with a substantial reduction in all-cause, liver- and drug-related mortality. The association of IDU and related syndemic factors with a higher risk of drug-related mortality calls for an integrated social support, addiction, and HCV care approach among people who inject drugs.
We assessed the effect of treatment of hepatitis C virus infection with direct-acting antiviral drugs on deaths from all causes, liver disease and drug use. We found that treatment with direct-acting antiviral drugs is associated with substantial lowering in risk of death from all causes, liver disease and drug use among people with hepatitis C virus infection.
我们评估了直接作用抗病毒药物（DAA）诱导的持续病毒学应答（SVR）对加拿大不列颠哥伦比亚省人群中全因、肝脏和药物相关死亡率的影响。
我们使用了不列颠哥伦比亚省肝炎检测者队列的数据，该队列包括自 1990 年以来接受 HCV 检测的人群，并与医疗就诊、住院、处方药物和死亡率的数据相关联。我们随访了接受 DAA 治疗的人群和未接受任何 HCV 治疗的人群，直到死亡或 2019 年 12 月 31 日。我们使用逆概率治疗加权来平衡治疗组和未治疗组的基线特征，并进行多变量比例风险模型分析以评估 DAA 对死亡率的影响。
我们的队列包括 10851 例接受 DAA 治疗的患者（SVR10426[96%]，无 SVR：425）和 10851 例匹配的未治疗患者。中位随访时间为 2.2 年（IQR 1.3-3.6；最长 6.2 年）。SVR 组的全因死亡率为 19.5/1000 人年（死亡 552 例），无 SVR 组为 86.5/1000 人年（死亡 96 例），未治疗组为 99.2/1000 人年（死亡 2 例，死亡 2133 例）。在多变量模型中，SVR 与全因（调整后的危险比[aHR]0.19；95%CI 0.17-0.21）、肝脏（调整后的亚分布风险比[aasHR]0.22，95%CI 0.18-0.27）和药物相关死亡率（调整后的亚分布风险比[aasHR]0.26，95%CI 0.21-0.32）显著降低相关，与未治疗相比。年龄较大和肝硬化与肝脏相关死亡率的风险增加相关，而年龄较小、注射吸毒（IDU）、有问题的酒精使用和 HIV/HBV 合并感染与药物相关死亡率的风险增加相关。
DAA 治疗与全因、肝脏和药物相关死亡率的显著降低相关。IDU 和相关综合征因素与药物相关死亡率风险增加相关，这需要在注射吸毒者中采取综合的社会支持、成瘾和 HCV 护理方法。
我们评估了直接作用抗病毒药物治疗丙型肝炎病毒感染对所有原因、肝脏疾病和药物使用相关死亡的影响。我们发现，直接作用抗病毒药物治疗与丙型肝炎病毒感染者全因、肝脏疾病和药物使用相关死亡风险的显著降低相关。
