The effectiveness of hepatitis C virus (HCV) treatment with pegylated interferon and
ribavirin usually is evaluated by the surrogate end point of sustained virologic response
(SVR), although the ultimate goal of antiviral treatment is to reduce mortality. The
impact of SVR on all-cause mortality is not well documented by HCV genotype or in
populations in routine medical practice with substantial comorbidities.
From the US Department of Veterans Affairs (VA), we identified all patients infected
with HCV genotypes 1, 2, or 3, without human immunodeficiency virus co-infection or
hepatocellular carcinoma before HCV treatment with pegylated interferon and ribavirin,
who started HCV treatment from January 2001 to June 2007, stopped treatment by June
2008, and had a posttreatment HCV RNA test result of SVR or no SVR. Mortality data
from VA and non-VA sources were available through 2009.
HCV genotypes 1, 2, or 3 cohorts consisted of 12,166, 2904, and 1794 patients, respectively,
with SVR rates of 35%, 72%, and 62%, respectively. Each cohort had high rates of comorbidities.
During a median follow-up period of approximately 3.8 years, 1119 genotype-1, 220
genotype-2, and 196 genotype-3 patients died. In genotype-specific multivariate survival
models that controlled for demographic factors, comorbidities, laboratory characteristics,
and treatment characteristics, an SVR was associated with substantially reduced mortality
risk for each genotype (genotype-1 hazard ratio, 0.70; P < .0001; genotype-2 hazard
ratio, 0.64; P = .006; genotype-3 hazard ratio, 0.51; P = .0002).
An SVR reduced mortality among patients infected with HCV of genotypes 1, 2, or 3
who were being treated by routine medical practice and had substantial comorbidities.
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.