Towards a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes

Hamish A. Innes (Lead / Corresponding author), Scott A. McDonald, John F. Dillon, Sam Allen, Peter C. Hayes, David Goldberg, Peter R. Mills, Stephen T. Barclay, David Wilks, Heather Valerio, Ray Fox, Diptendu Bhattacharyya, Nicholas Kennedy, Judith Morris, Andrew Fraser, Adrian J. Stanley, Peter Bramley, Sharon J. Hutchinson

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    Abstract

    Sustained viral response (SVR) is the optimal outcome of hepatitis C virus (HCV), yet more detailed data is required to confirm its clinical value. Individuals receiving treatment in 1996-2011 were identified using the Scottish HCV clinical database. We sourced data on 10 clinical events: liver, nonliver and all-cause mortality; first hospitalisation for severe liver morbidity (SLM): cardiovascular disease (CVD); respiratory disorders; neoplasms; alcohol-intoxication; drug-intoxication; and violence-related injury (note: the latter three events were selected a priori to gauge ongoing chaotic lifestyle behaviours).  We determined the association between SVR attainment and each outcome event, in terms of the relative hazard reduction and absolute risk reduction (ARR), We tested for an interaction between SVR and liver disease severity (mild vs. nonmild), defining mild disease as an aspartate aminotransferase-to-platelet ratio index (APRI) <0.7. Our cohort comprised 3385 patients (mean age: 41.6 years), followed-up for a median 5.3 years (interquartile range: 3.3-8.2). SVR was associated with a reduced risk of liver mortality (adjusted hazard ratio [AHR]:0.24; P<0.001), nonliver mortality (AHR:0.68; P=0.026); all-cause mortality (AHR:0.49; P<0.001), SLM (AHR:0.21; P<0.001), CVD (AHR:0.70; P=0.001); alcohol intoxication (AHR: 0.52; P=0.003) and violence-related injury (AHR:0.51; P=0.002) After 7.5 years, SVR was associated with significant ARRs for liver mortality, all-cause mortality,  SLM, and CVD (each 3.0%-4.7%). However, we detected a strong interaction, in that ARRs were considerably higher for individuals with nonmild disease, than for individuals with mild disease.

    Conclusions: The conclusions are three-fold: 1) Overall, SVR is associated with reduced hazard for a range of hepatic and non-hepatic events; 2) an association between SVR and behavioural events is consistent with SVR patients leading healthier lives; 3) the short-term value of SVR is greatest for those with nonmild disease.

    This article is protected by copyright. All rights reserved.

    Original languageEnglish
    Pages (from-to)355-364
    Number of pages10
    JournalHepatology
    Volume62
    Issue number2
    Early online date25 Mar 2015
    DOIs
    Publication statusPublished - Aug 2015

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    Hepatitis C
    Mortality
    Liver
    Alcoholic Intoxication
    Cardiovascular Diseases
    Morbidity
    Violence
    Hepacivirus
    Liver Diseases
    Numbers Needed To Treat
    Wounds and Injuries
    Virus Diseases
    Aspartate Aminotransferases
    Life Style
    Hospitalization
    Blood Platelets
    Databases
    Pharmaceutical Preparations
    Neoplasms

    Cite this

    Innes, Hamish A. ; McDonald, Scott A. ; Dillon, John F. ; Allen, Sam ; Hayes, Peter C. ; Goldberg, David ; Mills, Peter R. ; Barclay, Stephen T. ; Wilks, David ; Valerio, Heather ; Fox, Ray ; Bhattacharyya, Diptendu ; Kennedy, Nicholas ; Morris, Judith ; Fraser, Andrew ; Stanley, Adrian J. ; Bramley, Peter ; Hutchinson, Sharon J. / Towards a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes. In: Hepatology. 2015 ; Vol. 62, No. 2. pp. 355-364.
    @article{aac2b38889454ebe86f53db41a03bab2,
    title = "Towards a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes",
    abstract = "Sustained viral response (SVR) is the optimal outcome of hepatitis C virus (HCV), yet more detailed data is required to confirm its clinical value. Individuals receiving treatment in 1996-2011 were identified using the Scottish HCV clinical database. We sourced data on 10 clinical events: liver, nonliver and all-cause mortality; first hospitalisation for severe liver morbidity (SLM): cardiovascular disease (CVD); respiratory disorders; neoplasms; alcohol-intoxication; drug-intoxication; and violence-related injury (note: the latter three events were selected a priori to gauge ongoing chaotic lifestyle behaviours).  We determined the association between SVR attainment and each outcome event, in terms of the relative hazard reduction and absolute risk reduction (ARR), We tested for an interaction between SVR and liver disease severity (mild vs. nonmild), defining mild disease as an aspartate aminotransferase-to-platelet ratio index (APRI) <0.7. Our cohort comprised 3385 patients (mean age: 41.6 years), followed-up for a median 5.3 years (interquartile range: 3.3-8.2). SVR was associated with a reduced risk of liver mortality (adjusted hazard ratio [AHR]:0.24; P<0.001), nonliver mortality (AHR:0.68; P=0.026); all-cause mortality (AHR:0.49; P<0.001), SLM (AHR:0.21; P<0.001), CVD (AHR:0.70; P=0.001); alcohol intoxication (AHR: 0.52; P=0.003) and violence-related injury (AHR:0.51; P=0.002) After 7.5 years, SVR was associated with significant ARRs for liver mortality, all-cause mortality,  SLM, and CVD (each 3.0{\%}-4.7{\%}). However, we detected a strong interaction, in that ARRs were considerably higher for individuals with nonmild disease, than for individuals with mild disease.Conclusions: The conclusions are three-fold: 1) Overall, SVR is associated with reduced hazard for a range of hepatic and non-hepatic events; 2) an association between SVR and behavioural events is consistent with SVR patients leading healthier lives; 3) the short-term value of SVR is greatest for those with nonmild disease. This article is protected by copyright. All rights reserved.",
    author = "Innes, {Hamish A.} and McDonald, {Scott A.} and Dillon, {John F.} and Sam Allen and Hayes, {Peter C.} and David Goldberg and Mills, {Peter R.} and Barclay, {Stephen T.} and David Wilks and Heather Valerio and Ray Fox and Diptendu Bhattacharyya and Nicholas Kennedy and Judith Morris and Andrew Fraser and Stanley, {Adrian J.} and Peter Bramley and Hutchinson, {Sharon J.}",
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    year = "2015",
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    doi = "10.1002/hep.27766",
    language = "English",
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    pages = "355--364",
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    Innes, HA, McDonald, SA, Dillon, JF, Allen, S, Hayes, PC, Goldberg, D, Mills, PR, Barclay, ST, Wilks, D, Valerio, H, Fox, R, Bhattacharyya, D, Kennedy, N, Morris, J, Fraser, A, Stanley, AJ, Bramley, P & Hutchinson, SJ 2015, 'Towards a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes', Hepatology, vol. 62, no. 2, pp. 355-364. https://doi.org/10.1002/hep.27766

    Towards a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes. / Innes, Hamish A. (Lead / Corresponding author); McDonald, Scott A.; Dillon, John F.; Allen, Sam; Hayes, Peter C.; Goldberg, David; Mills, Peter R.; Barclay, Stephen T.; Wilks, David; Valerio, Heather; Fox, Ray; Bhattacharyya, Diptendu; Kennedy, Nicholas; Morris, Judith; Fraser, Andrew; Stanley, Adrian J.; Bramley, Peter; Hutchinson, Sharon J.

    In: Hepatology, Vol. 62, No. 2, 08.2015, p. 355-364.

    Research output: Contribution to journalArticle

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    T1 - Towards a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes

    AU - Innes, Hamish A.

    AU - McDonald, Scott A.

    AU - Dillon, John F.

    AU - Allen, Sam

    AU - Hayes, Peter C.

    AU - Goldberg, David

    AU - Mills, Peter R.

    AU - Barclay, Stephen T.

    AU - Wilks, David

    AU - Valerio, Heather

    AU - Fox, Ray

    AU - Bhattacharyya, Diptendu

    AU - Kennedy, Nicholas

    AU - Morris, Judith

    AU - Fraser, Andrew

    AU - Stanley, Adrian J.

    AU - Bramley, Peter

    AU - Hutchinson, Sharon J.

    N1 - © 2015 by the American Association for the Study of Liver Diseases.

    PY - 2015/8

    Y1 - 2015/8

    N2 - Sustained viral response (SVR) is the optimal outcome of hepatitis C virus (HCV), yet more detailed data is required to confirm its clinical value. Individuals receiving treatment in 1996-2011 were identified using the Scottish HCV clinical database. We sourced data on 10 clinical events: liver, nonliver and all-cause mortality; first hospitalisation for severe liver morbidity (SLM): cardiovascular disease (CVD); respiratory disorders; neoplasms; alcohol-intoxication; drug-intoxication; and violence-related injury (note: the latter three events were selected a priori to gauge ongoing chaotic lifestyle behaviours).  We determined the association between SVR attainment and each outcome event, in terms of the relative hazard reduction and absolute risk reduction (ARR), We tested for an interaction between SVR and liver disease severity (mild vs. nonmild), defining mild disease as an aspartate aminotransferase-to-platelet ratio index (APRI) <0.7. Our cohort comprised 3385 patients (mean age: 41.6 years), followed-up for a median 5.3 years (interquartile range: 3.3-8.2). SVR was associated with a reduced risk of liver mortality (adjusted hazard ratio [AHR]:0.24; P<0.001), nonliver mortality (AHR:0.68; P=0.026); all-cause mortality (AHR:0.49; P<0.001), SLM (AHR:0.21; P<0.001), CVD (AHR:0.70; P=0.001); alcohol intoxication (AHR: 0.52; P=0.003) and violence-related injury (AHR:0.51; P=0.002) After 7.5 years, SVR was associated with significant ARRs for liver mortality, all-cause mortality,  SLM, and CVD (each 3.0%-4.7%). However, we detected a strong interaction, in that ARRs were considerably higher for individuals with nonmild disease, than for individuals with mild disease.Conclusions: The conclusions are three-fold: 1) Overall, SVR is associated with reduced hazard for a range of hepatic and non-hepatic events; 2) an association between SVR and behavioural events is consistent with SVR patients leading healthier lives; 3) the short-term value of SVR is greatest for those with nonmild disease. This article is protected by copyright. All rights reserved.

    AB - Sustained viral response (SVR) is the optimal outcome of hepatitis C virus (HCV), yet more detailed data is required to confirm its clinical value. Individuals receiving treatment in 1996-2011 were identified using the Scottish HCV clinical database. We sourced data on 10 clinical events: liver, nonliver and all-cause mortality; first hospitalisation for severe liver morbidity (SLM): cardiovascular disease (CVD); respiratory disorders; neoplasms; alcohol-intoxication; drug-intoxication; and violence-related injury (note: the latter three events were selected a priori to gauge ongoing chaotic lifestyle behaviours).  We determined the association between SVR attainment and each outcome event, in terms of the relative hazard reduction and absolute risk reduction (ARR), We tested for an interaction between SVR and liver disease severity (mild vs. nonmild), defining mild disease as an aspartate aminotransferase-to-platelet ratio index (APRI) <0.7. Our cohort comprised 3385 patients (mean age: 41.6 years), followed-up for a median 5.3 years (interquartile range: 3.3-8.2). SVR was associated with a reduced risk of liver mortality (adjusted hazard ratio [AHR]:0.24; P<0.001), nonliver mortality (AHR:0.68; P=0.026); all-cause mortality (AHR:0.49; P<0.001), SLM (AHR:0.21; P<0.001), CVD (AHR:0.70; P=0.001); alcohol intoxication (AHR: 0.52; P=0.003) and violence-related injury (AHR:0.51; P=0.002) After 7.5 years, SVR was associated with significant ARRs for liver mortality, all-cause mortality,  SLM, and CVD (each 3.0%-4.7%). However, we detected a strong interaction, in that ARRs were considerably higher for individuals with nonmild disease, than for individuals with mild disease.Conclusions: The conclusions are three-fold: 1) Overall, SVR is associated with reduced hazard for a range of hepatic and non-hepatic events; 2) an association between SVR and behavioural events is consistent with SVR patients leading healthier lives; 3) the short-term value of SVR is greatest for those with nonmild disease. This article is protected by copyright. All rights reserved.

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