PMID- 31078544
OWN - NLM
STAT- MEDLINE
DCOM- 20201124
LR  - 20201124
IS  - 1600-0641 (Electronic)
IS  - 0168-8278 (Linking)
VI  - 71
IP  - 2
DP  - 2019 Aug
TI  - Declining hepatitis C virus-related liver disease burden in the direct-acting 
      antiviral therapy era in New South Wales, Australia.
PG  - 281-288
LID - S0168-8278(19)30275-2 [pii]
LID - 10.1016/j.jhep.2019.04.014 [doi]
AB  - BACKGROUND & AIMS: Population-level evidence for the impact of direct-acting 
      antiviral (DAA) therapy on hepatitis C virus (HCV)-related disease burden is 
      lacking. We aimed to evaluate trends in HCV-related decompensated cirrhosis and 
      hepatocellular carcinoma (HCC) hospitalisation, and liver-related and all-cause 
      mortality in the pre-DAA (2001-2014) and DAA therapy (2015-2017) eras in New 
      South Wales, Australia. METHODS: HCV notifications (1993-2016) were linked to 
      hospital admissions (2001-2017) and mortality (1995-2017). Segmented Poisson 
      regressions and Poisson regression were used to assess the impact of DAA era and 
      factors associated with liver-related mortality, respectively. RESULTS: Among 
      99,910 people with an HCV notification, 3.8% had a decompensated cirrhosis 
      diagnosis and 1.8% had an HCC diagnosis, while 3.3% and 10.5% died of 
      liver-related and all-cause mortality, respectively. In the pre-DAA era, the 
      number of decompensated cirrhosis and HCC diagnoses, and liver-related and 
      all-cause mortality consistently increased (incidence rate ratios 1.04 [95% CI 
      1.04-1.05], 1.08 [95% CI 1.07-1.08], 1.07 [95% CI 1.06-1.07], and 1.05 [95% CI 
      1.04-1.05], respectively) over each 6-monthly band. In the DAA era, decompensated 
      cirrhosis diagnosis and liver-related mortality numbers declined (incidence rate 
      ratios 0.97 [95% CI 0.95-0.99] and 0.96 [95% CI 0.94-0.98], respectively), and 
      HCC diagnosis and all-cause mortality numbers plateaued (incidence rate ratio 
      1.00 [95% CI 0.97-1.03] and 1.01 [95% CI 1.00-1.02], respectively) over each 
      6-monthly band. In the DAA era, alcohol-use disorder (AUD) was common in patients 
      diagnosed with decompensated cirrhosis and HCC (65% and 46% had a history of AUD, 
      respectively). AUD was independently associated with liver-related mortality 
      (incidence rate ratio 3.35; 95% CI 3.14-3.58). CONCLUSIONS: In the DAA era, there 
      has been a sharp decline in liver disease morbidity and mortality in New South 
      Wales, Australia. AUD remains a major contributor to HCV-related liver disease 
      burden, highlighting the need to address comorbidities. LAY SUMMARY: Rising 
      hepatitis C-related morbidity and mortality is a major public health issue. 
      However, development of highly effective medicines against hepatitis C (called 
      direct-acting antivirals or DAAs) means hepatitis C could be eliminated as a 
      public health threat by 2030. This study shows a sharp decline in liver disease 
      morbidity and mortality since the introduction of DAAs in New South Wales, 
      Australia. Despite this, heavy alcohol use remains an important risk factor for 
      liver disease among people with hepatitis C. To ensure that the benefits of new 
      antiviral treatments are not compromised, management of major comorbidities, 
      including heavy alcohol use must improve among people with hepatitis C.
CI  - Copyright (c) 2019 European Association for the Study of the Liver. All rights 
      reserved.
FAU - Alavi, Maryam
AU  - Alavi M
AD  - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. Electronic address: 
      msalehialavi@kirby.unsw.edu.au.
FAU - Law, Matthew G
AU  - Law MG
AD  - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
FAU - Valerio, Heather
AU  - Valerio H
AD  - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
FAU - Grebely, Jason
AU  - Grebely J
AD  - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
FAU - Amin, Janaki
AU  - Amin J
AD  - Department of Health Systems and Populations, Macquarie University, Sydney, NSW, 
      Australia.
FAU - Hajarizadeh, Behzad
AU  - Hajarizadeh B
AD  - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
FAU - Selvey, Christine
AU  - Selvey C
AD  - Communicable Diseases Branch, Health Protection NSW, Sydney, NSW, Australia.
FAU - George, Jacob
AU  - George J
AD  - Storr Liver Centre, Westmead Millennium Institute, University of Sydney and 
      Westmead Hospital, Westmead, NSW, Australia.
FAU - Dore, Gregory J
AU  - Dore GJ
AD  - The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190510
PL  - Netherlands
TA  - J Hepatol
JT  - Journal of hepatology
JID - 8503886
RN  - 0 (Antiviral Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Alcoholism/complications
MH  - Antiviral Agents/*therapeutic use
MH  - Carcinoma, Hepatocellular/epidemiology/*etiology/mortality
MH  - Female
MH  - Follow-Up Studies
MH  - Hepacivirus/*immunology
MH  - Hepatitis C, Chronic/*complications/*drug therapy/epidemiology/mortality
MH  - Hospitalization/trends
MH  - Humans
MH  - Incidence
MH  - Liver Cirrhosis/epidemiology/*etiology/mortality
MH  - Liver Neoplasms/epidemiology/*etiology/mortality
MH  - Male
MH  - Middle Aged
MH  - New South Wales/epidemiology
MH  - Risk Factors
OTO - NOTNLM
OT  - Decompensated cirrhosis
OT  - Direct-acting antivirals
OT  - Hepatitis C
OT  - Hepatocellular carcinoma
OT  - Mortality
EDAT- 2019/05/13 06:00
MHDA- 2020/11/25 06:00
CRDT- 2019/05/13 06:00
PHST- 2018/10/02 00:00 [received]
PHST- 2019/03/27 00:00 [revised]
PHST- 2019/04/01 00:00 [accepted]
PHST- 2019/05/13 06:00 [pubmed]
PHST- 2020/11/25 06:00 [medline]
PHST- 2019/05/13 06:00 [entrez]
AID - S0168-8278(19)30275-2 [pii]
AID - 10.1016/j.jhep.2019.04.014 [doi]
PST - ppublish
SO  - J Hepatol. 2019 Aug;71(2):281-288. doi: 10.1016/j.jhep.2019.04.014. Epub 2019 May 
      10.