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Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders

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Abstract

Background

As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated.

Aim

To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients.

Methods

Patients with chronic HCV were prospectively enrolled in 1999–2000 from 11 VA medical centers and followed through retrospective medical record review.

Results

A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46–0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up—factors typically associated with treatment eligibility.

Conclusions

As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.

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Abbreviations

VA:

U.S. Department of Veterans Affairs

VHA:

Veterans Health Administration

HBV:

Hepatitis B virus

HBsAg:

Hepatitis B surface antigen

HIV:

Human immunodeficiency virus

IFNα:

Interferon-α

RBV:

Ribavirin

SVR:

Sustained virologic response

HCC:

Hepatocellular carcinoma

HDI:

Health data and information

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Acknowledgments

Grant Support: VA Merit 1I01 CX000295-01A1 (PI: Monto) and the UCSF Liver Center NIH P30 DK026743 (Monto, Ryan).

Author information

Authors and Affiliations

  1. San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA

    Myrna L. Cozen, James C. Ryan, Hui Shen & Alexander Monto

  2. Palo Alto VA Medical Center and Stanford University, 3801 Miranda Ave, GI/Hepatology #154C, Palo Alto, CA, 94304-1207, USA

    Ramsey Cheung

  3. Philadelphia VA Medical Center and University of Pennsylvania, A212 Medical Research, University and Woodland Ave, Philadelphia, PA, 19104, USA

    David E. Kaplan & Kyong-Mi Chang

  4. Minneapolis VA Medical Center, 1 Veterans Drive, GI, Minneapolis, MN, 55417, USA

    Christine Pocha

  5. Bronx VA Medical Center, 130 W. Kingsbridge Rd, Bronx, NY, 10468, USA

    Norbert Brau

  6. New York Harbor Brooklyn and Manhattan VA Medical Centers, 800 Poly Pl, Brooklyn, NY, 11209, USA

    Ayse Aytaman

  7. Iowa City VA Medical Center and the University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA

    Warren N. Schmidt

  8. Boston VA Health Care System and AbbVie Pharmaceuticals, 85 E. Concord St. #7700, Boston, MA, 02118, USA

    Marcos Pedrosa

  9. Houston VA Medical Center and Baylor University, Digestive Disease Section, #111D, 2002 Holcombe Blvd, Houston, TX, 77030-4211, USA

    Bhupinderjit S. Anand

  10. Long Beach VA Medical Center and University of California Irvine, #111G, 5901 E. 7th Street, Long Beach, CA, 90822-5201, USA

    Timothy Morgan

Authors
  1. Myrna L. Cozen
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  2. James C. Ryan
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  3. Hui Shen
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  4. Ramsey Cheung
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  5. David E. Kaplan
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  9. Warren N. Schmidt
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  13. Timothy Morgan
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  14. Alexander Monto
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Corresponding author

Correspondence to Alexander Monto.

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Conflict of interest

All authors declare that they have no conflict of interest related to the data or interpretation of this study.

Additional information

Myrna L. Cozen and James C. Ryan have participated equally to this work.

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Cozen, M.L., Ryan, J.C., Shen, H. et al. Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders. Dig Dis Sci 61, 1744–1756 (2016). https://doi.org/10.1007/s10620-016-4122-5

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