Hepatitis C is a serious infection because it causes early death in many patients. HCV is the most
common cause of cirrhosis in the US, more common than alcohol. If you examine the cause of death
in Americans, liver disease is very low on the list. The CDC lists the causes of death here.
2,423,712 Americans died in 2007. 29,165 died from Chronic liver disease and cirrhosis. The average
American is more likely to die from suicide than from cirrhosis. However, if you are infected with
HCV, chronic liver disease and cirrhosis are much more likely to cause your death. Liver disease jumps
up to number one or number two on the list. We have about 80 million baby boomers in the US. About
7% of the males are infected with HCV. Those 2.8 million men are in danger of premature death.
As they get cirrhosis followed by either liver failure or liver cancer they experience premature
mortality. There are not enough liver transplants to save them. The obvious solution
to this problem is to cure the HCV infection. This stops liver injury, liver fibrosis and the progression
to cirrhosis. It can prevent the need for a liver transplant and can reduce deaths from liver disease.
Why not die from a heart attack at 98 instead of liver failure or cancer at 58?
Look at figure 3 below. It compares how Americans died in 1900, 1950 and 2002. In 1900, about 20% of
Americans died before age 5. Now 80% of Americans are live to at least 70. Half of us live to age 82 or
longer. We are mortal and very few live to be 100.
Look at the life table below from 2002. Look at the second column that shows the death rate each year.
The death rate does not go above one percent per year until age 61-62.
Look at the death rate for age 79-80 and see that it is about 5% per year. This brings home the accelerated
mortality of HCV cirrhosis. Patients are middle aged but die at the same speed as someone who is 79-80.
We looked at the survival of patients with hepatitis C, and I reported the results to
EASL April 14, 2005 in Paris. Patients with HCV who achieved sustained virologic
response had much better survival than those who were not successfully treated.
3 of 74 (4%) patients with SVR died while 49 of 195 (25%) without SVR died.
Sustained viral response improves patient survival with either compensated or decompensated
Results: 3 of 74 (4%) patients with SVR died while 49 of 195 (25%) without SVR
died. 5 of 28 (18%) decompensated patients achieved SVR, and 4 (80%) are alive.
1 died from HCC. 20 of 23 (87%) decompensated patients without SVR died.
Multiple logistic regression indicated that decompensated liver disease, lack of
SVR and history of alcohol or drug abuse predicted mortality. LR chi2 (3) =
83.09 Prob > chi2 = 0.0000 Two of our patients received liver transplants, one
for HCC and one for decompensated liver disease. Both were nonresponders to