Hepatitis C virus infection and risk of liver-related and non-liver-related deaths: a population-based cohort study in Naples, southern Italy
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Published:2021-07-08
Issue:1
Volume:21
Page:
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ISSN:1471-2334
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Container-title:BMC Infectious Diseases
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language:en
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Short-container-title:BMC Infect Dis
Author:
Piselli Pierluca, Serraino Diego, Fusco Mario, Girardi Enrico, Pirozzi Angelo, Toffolutti Federica, Cimaglia Claudia, Taborelli MartinaORCID, Capobianchi Mariarosaria, Carletti Fabrizio, Garbuglia Anna R., Ippolito Giuseppe, Scognamiglio Paola, Di Cicco Pietro, Gigli Letizia, Russospena Silvana, Palombino Raffaele, Panato Chiara, Mattioli Veronica, Dal Maso Luigino,
Abstract
Abstract
Background
Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. This study aimed to evaluate the impact of HCV infection on all-cause, liver-related, and non-liver-related mortality in a population living in an area with a high prevalence of HCV infection before the advent of Direct-Acting Antiviral (DAA) therapies, and to identify factors associated with cause-specific mortality among HCV-infected individuals.
Methods
We conducted a cohort study on 4492 individuals enrolled between 2003 and 2006 in a population-based seroprevalence survey on viral hepatitis infections in the province of Naples, southern Italy. Study participants provided serum for antibodies to HCV (anti-HCV) and HCV RNA testing. Information on vital status to December 2017 and cause of death were retrieved through record-linkage with the mortality database. Hazard ratios (HRs) for cause-specific mortality and 95% confidence intervals (CIs) were estimated using Fine-Grey regression models.
Results
Out of 626 deceased people, 20 (3.2%) died from non-natural causes, 56 (8.9%) from liver-related conditions, 550 (87.9%) from non-liver-related causes. Anti-HCV positive people were at higher risk of death from all causes (HR = 1.38, 95% CI: 1.12–1.70) and liver-related causes (HR = 5.90, 95% CI: 3.00–11.59) than anti-HCV negative ones. Individuals with chronic HCV infection reported an elevated risk of death due to liver-related conditions (HR = 6.61, 95% CI: 3.29–13.27) and to any cause (HR = 1.51, 95% CI: 1.18–1.94). The death risk of anti-HCV seropositive people with negative HCV RNA was similar to that of anti-HCV seronegative ones. Among anti-HCV positive people, liver-related mortality was associated with a high FIB-4 index score (HR = 39.96, 95% CI: 4.73–337.54).
Conclusions
These findings show the detrimental impact of HCV infection on all-cause mortality and, particularly, liver-related mortality. This effect emerged among individuals with chronic infection while those with cleared infection had the same risk of uninfected ones. These results underline the need to identify through screening all people with chronic HCV infection notably in areas with a high prevalence of HCV infection, and promptly provide them with DAAs treatment to achieve progressive HCV elimination and reduce HCV-related mortality.
Funder
Associazione Italiana per la Ricerca sul Cancro, Milan, Italy International Agency for Cancer Research, Lyon, France Ricerca Corrente Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy IRCCS Istituto Nazionale per le Malattie Infettive L. Spallanzani, Rome, Italy
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases
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