HCV Most Common Infectious Cause of Death, Yet Still Underestimated

Hepatitis C infection causes more deaths than HIV, hepatitis B, and tuberculosis combined.

Despite the advent of direct acting antivirals (DAAs) in the fight against hepatitis C virus (HCV) in recent years, deaths related to HCV infection continue to rise in the United States, according to data presented at IDWeek 2015 in San Diego, California.

Even though death certificate data indicates that hepatitis C is the most common infectious cause of death, even more so than HIV, hepatitis B and tuberculosis combined, HCV-related mortality is still likely underestimated.

According to the US Centers for Disease Control and Prevention, there are between 3 and 4 million people living with HCV in the United States. Many of those infected were born between the years of 1945 and 1965; however, new data shows a spike in infections among younger intravenous drug users.

HCV has the potential to advance to severe liver disease including cirrhosis, liver cancer and end-stage liver failure. The virus is also the leading cause of liver transplantation, according to aidsmap.com.

A new study that evaluated a national multiple-cause-of-death (MCOD) database from 2003 to 2013 and data from the Chronic Hepatitis Cohort Study (CHeCS), which showed deaths with hepatitis C recorded on death certificates increased from 11,051 in 2003 to nearly 20,000 in 2013.

Deaths associated with all 59 other notifiable infectious conditions decreased from nearly 25,000 in 2003 to just 18,002 in 2013. The study also analyzed “hidden” mortality rates among people believed to have access to evolving HCV care and curative treatments.

Among more than 12,000 people receiving care in the CHeCS, the mortality rate doubled from about 2.3 per 100 person-years to 5.5 per 100 person-years from 2007 to 2013, respectively.

Of 1600 CHeCS patients who died, only 19% had HCV listed as the cause of death on their certificates, even though more than 75% showed evidence of liver disease prior to death, according to aidsmap.com.

When taking this percentage and applying it to the general population, it can be estimated that 75,000 deaths in 2013 were attributable to HCV.

“Deaths in chronic HCV-infected persons, even when grossly under-enumerated on death certificates, far outstrip deaths from 60 other infectious conditions reportable to CDC,” the investigators concluded. “Control of the ‘chronic’ and the ‘acute’ outbreaks will require a multipronged approach, with interventions along a testing-to-cure continuum of care.”

According to the analysis, the hepatitis C cascade of care shows that of the 3.2 million people living with HCV in the United States, 50% have had HCV antibody tests, 38% have received hepatitis C care, 23% have had HCV RNA tests, 11% have received treatment and only 6% have achieved sustained virological response, or what is considered to be cured.

Data from Gilead Sciences, producers of two of the curative treatments for HCV, Sovaldi (sofosbuvir) and Harvoni, shows that prescriptions for sofosbuvir-based regimens reached 470,000 in the second quarter of 2015.

Yet, while the number of people receiving HCV treatment rises, barriers still exist to achieving universal treatment. Some of these barriers include the expense of treatment, clinicians thinking hepatitis C is a benign chronic condition that doesn’t require treatment, and reluctance to help people who inject drugs.

As more competition enters the marketplace and people become more educated about the risk factors that accompany an HCV infection, the frequency of HCV-related deaths should go down over time.