Risk for liver-related death in injection drug users with HCV increased with age

Kielland KB. J Hepatol. 2012;doi:10.1016/j.jhep.2012.08.024.

September 18, 2012

Injection drug users with HCV were found at increased risk for death from all causes up to 30 years after HCV transmission, with greater risk for liver-related death according to age, in a recent study.

Researchers evaluated 523 anti-HCV-positive injection drug users (IDUs) with stored, frozen sera who had been admitted for resident drug abuse treatment between 1970 and 1984 at a Norwegian medical facility, for a mean 33 years of observation. Mortality due to liver-related or other causes was compared between patients who were HCV RNA positive (n=328) and negative (n=195).

During follow-up, 220 patients died. The mortality rate associated with all causes was 1.85 (1.62-2.11) per 100 person-years for the entire cohort, with a higher rate for males than females (2.11, 1.84-2.46 vs. 1.39, 1.07-1.79). Among RNA-positive patients, the mortality rate was 1.75 (1.47-2.07) compared with 2.05 (1.66-2.54) for RNA-negative patients (P=.248 for difference) (95% CI for all).

Common causes of death across the entire cohort included drug or alcohol intoxication (49.5%), suicide (9.1%) and accident (8.2%), with no significant differences between groups in terms of cause distribution (P=.598). Among HCV RNA-positive patients, 7.5% of deaths were due to liver disease, with a rate for deaths related to HCV of 0.09 per 100 person-years (95% CI, 0.05-0.16).

Of 17 RNA-positive patients aged 50 and 60 years who died, five were attributed to liver disease. Mortality incidence due to liver-related issues increased with age, with a cumulative rate of 0.07 (0.03-0.17) per 100 person-years for patients aged 49 years and younger and 0.91 (0.38-2.18) for patients aged 50 years and older (95% CI for both).

“The present study, on one hand, illustrates the high mortality rate among IDUs from drug-related causes,” the researchers wrote. “On the other hand, it shows increased morbidity and mortality due to HCV with increasing age and time since HCV transmission. This may be moderated by increased antiviral treatment. In the long term, serious HCV-related liver disease could be reduced through decreased intravenous drug use, more intensive prevention of syringe sharing among IDUs, and consequently, reduced transmission of viral hepatitis.”

Disclosure: See the study for a full list of relevant disclosures.

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