Study Reveals Increased Cirrhosis Prevalence in US Patients with HCV

Over the past decade, there has been a significant increase in liver cirrhosis and decomposition among patients with hepatitis C virus (HCV).

Cirrhosis is developed after a patient’s liver has healed itself following excessive scarring, or fibrosis, which usually occurs in most patients who have chronic HCV infections. There are two types of cirrhosis, compensated and decompensated. Patients do not present with cirrhosis-related symptoms when they have compensated cirrhosis, but may have esophageal or gastric varices. On the other hand, patients with decompensated cirrhosis usually present with hepatic insufficiencies, such as jaundice, or portal hypertension-related symptoms, such as variceal hemorrhage.

Although there is an association between cirrhosis, decompensated cirrhosis, and death, the prevalence of cirrhosis among HCV patients had not previously been observed in real-world US-based studies, according to a press release from the American Association for the Study of Liver Diseases (AASLD). In a recent study, investigators sought to identify the prevalence of these three conditions among 11,169 adults in the United States between 2006 and 2014.

“Previous estimates had suggested that the medical burden of chronic hepatitis C and its complications would increase in the US given the aging of the population, including the ‘baby boomer’ cohort born between 1945 and 1965 who are at the highest risk for infection,” said lead investigator Stuart C. Gordon. “We attempted to a) gauge whether, in fact, HCV related cirrhosis and its complications were increasing and b) if so, whether there were disparities among different populations in order to better target for treatment those groups that may be at higher risk of poor outcomes.”

The analysis was part of a larger study called the Chronic Hepatitis Cohort Study (CHeCS). Those included in the study received care at four large healthcare systems that participated in the CHeCS study.

Cirrhosis was identified using liver biopsy reports, serum markers of liver scarring, and ICD-9 diagnostic codes. Additionally, the investigators used a set of ICD-9 codes, which have been shown to predict decompensated cirrhosis.

After identifying patients with cirrhosis, the investigators examined the annual percentage change between several different time points to identify any trends. They found that the prevalence of cirrhosis among patients with HCV increased from 20.5% in 2006 to 28.5% in 2014, with the most significant increase occurring from 2006 to 2007.

The prevalence of decompensated cirrhosis varied among patients of various age groups. Over the study period, it increased by approximately 2% per year in patients aged 60 years and older, whereas in younger patients it largely remained the same.

“The proportion of hepatitis C patients with cirrhosis and its complications has grown significantly in the past decade, particularly among those over 60,” Gordon said. “The present analysis confirms the rising burden of chronic hepatitis C infection, and its complications, on the US health care system. These rising rates may have leveled off in recent years, however, possibly related to better options for treating HCV infection.”

In 2006, deaths in this patient group nearly doubled from 1.7% to 3.2% in 2013. However, a majority of this increase occurred prior to 2010, after which the death rates leveled off, according to the investigators.

“Future studies will help determine whether increased uptake of these newer medications can help stem the tide of HCV disease progression.”