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October 3 -7, 2019
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HCV-Related Mortality in US Fell 4% Yearly After Arrival of DAAs
  IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
After direct-acting antiviral (DAA) therapy for HCV infection became available in the United States, HCV-associated mortality fell 4% yearly from 2014 through 2017 [1]. HCV mortality proved higher in men than women and in blacks than whites or Asians.
Multiple-Cause-of-Death (MCOD) data indicate that HCV-related mortality rose 6.2% yearly in the United States from 2003 through 2013 [2]. Drexel University researchers used MCOD data from 2014 through 2017, the first years of the DAA era, to track changes in HCV-related mortality in the United States.
Analyzing death certificate information, the investigators used ICD-10 codes to determine all-cause mortality associated with HCV in 2014, 2015, 2016, and 2017. They calculated age-adjusted crude mortality and analyzed overall HCV-associated mortality stratified by race and gender.
HCV-associated deaths fell from 19,613 in 2014, to 19,566 in 2015, to 18,093 in 2016, and to 17,253 in 2017. The drop in mortality averaged 4% each year. Over those 4 years crude HCV mortality waned from 6.2 to 6.1 to 5.6 to 5.3 per 100,000 people.
Throughout 2014-2017, crude HCV-associated death rate per 100,000 people was almost 3-fold higher in the 55-to-64 age group than in the 45-to-54 age group (22.5 versus 7.8 per 100,000). HCV-associated mortality was more than twice higher in males than females (8.4 versus 3.3 per 100,000) and higher in blacks (7.8) than in whites (5.7) or Asians (2.0).
Age-adjusted HCV-related mortality per 100,000 people slipped from 5 in 2014, to 4.9 in 2015, to 4.4 in 2016, and to 4.1 in 2017. Over those same 4 years, age-adjusted HBV-associated mortality did not budge from 0.5 per 100,000 people.
The researchers cautioned that these calculations are limited because half of HCV infections remain undiagnosed in the United States and HCV may not be mentioned in death certificates, which are often written by someone other than the primary care physician.
With those limitations in mind, the investigators concluded that HCV-associated mortality fell in the United States after the introduction of DAAs in 2014. HCV mortality differences by gender and race, they suggested, may reflect differences in HCV prevalence. The Drexel team argued that, "with the availability of effective, well-tolerated HCV treatment, aggressive HCV screening and linkage to care are warranted, especially in high-risk populations.
1. Wasti Z, Coppock D, Chou E, Lee DH. Decreased hepatitis C virus-associated mortality in the U.S. 2014-2017 after new oral direct-acting antiviral era. IDWeek, October 2-6, 2019, Washington, DC. Abstract 2899.
2. Ly KN, Hughes EM, Jiles RB, Holmberg SD. Rising mortality associated with hepatitis C virus in the United States, 2003-2013. Clin Infect Dis. 2016;6:1287-1288.