YMMV; Hepatitis C May Not Increase Mortality among Patients Who Are Not....

[Willy50]

Explain this one to me;

Hepatitis C May Not Increase Mortality among Patients Who Are Not Co-infected, Do Not Drink Heavily, and Do Not Have Cirrhosis

http://www.hivandhepatitis.com/hep_c/news/2009/092509_b.html

I won't copy and paste the text into this but to some extent this flies in the face of what is often presented to us; that we all progress into cirrhosis and die.  Vertex, for instance has been quoting  a study which proposes that if a person has HCV long enough virtually everybody will progress to cirrhosis.  

So....which is it?

By the way......I resemble the title; don't drink, smoke, do the exercise thing, not co-infected and am not cirrhotic.  I'm 56, a male (there's 2 strikes against me already), have possibly had this since the mid 70's (shite; that's 3 strikes) and yet as of 2008 I am a 1/6 ishak.  

If you have read this board and know of a few peoples histology you will know I am not unique.

I haven't read the actual study yet but this distillation does not say that I won't progress...., doesn't say I won't become cirrhotic or suffer extra-hepatic diseases and symptoms..... just that our rate of death may be the same as every body else (who ain't taking care of themselves?)

Anyway..... I just thought I'd put this up there for people who are feeling like they neeeeed to treat last week.  I'll have to read the actual study and interested to hear feedback on what this actually means (and of course what it does NOT mean).  ; )

It reads like good news if you only read the title......

best,
Willy

[tashka]

Also not everybody who has cirrhosis will inevitably die fron it. With early stage compensated cirrhosis patient can live for decades without need for transplant. We have some people on this forum who can confirm this.

[Willy50]

Marc, I see this very much the same as you.  IF you were looking at stage 1's 2's and 3's you might expect no mortality, at least none which pertained to HCV.  This group is not impervious to deaths from cancer or from car accidents and they would have the same rate of death as the non-infected.
I agree wholeheartedly that the study would mean much more if it were for a longer time.  Only a much longer term study would mean much about finding a true rate of death.  I have no idea the demographics of this group, exclusion/inclusion practices.  When did the find this group, what are the ages, and is it possible that the group doesn't accurately reflect the HCV infected demographic?

On the other hand...... here's what caught my eye..... since we expect few mortalities....

This group had a 4.5 times decrease in mortality;
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"-Not coinfected with HIV or hepatitis B;
- Did not have cirrhosis;
- Had HCV genotypes other than 3;
- Did not inject drugs;
- Not heavy alcohol consumers (defined as < 40 g/day). "
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So on one hand I would not expect to see many deaths.... On the other hand there were indeed deaths.  If one excludes oneself from the above group one has significantly better odds of survival.

This is of some significance.  I don't completely dismiss it but neither do i think it proves much.  What it may say is that IV users OD, a significant number who are ALL of the above die of disease, maybe some die from drinking and driving---we don't know the cause of mortality.

The banner headline causes us to draw a conclusion but the study may not support the conclusion.

There is a tension between what the study says and what the pharms say.  I believe that the pharms are selling and they will use studies to sell TX.

Has anybody seen a study which might be used to promote simple lifestyle changes as it pertains to HCV survival rate?  LOL; I haven't seen much.  This study goes a certain distance in promoting the abstaining of alcohol use but does not differentiate it sufficiently.  I hope that they continue the followup.

Note; the study does not say that people do not progress in staging ot that they won't die of the disease, merely that they may do so at the rate of the norm,  I believe that given time the rates will spike.  I also believe that one can offset that(some) with lifestyle practices.

(slightly off topic but I also believe that genetics plays into this, but not exclusively so)

Bel, those stats were based on the old demographic after 20 years of infection.  the newer study that Vertex was quoting was that same group but after 30 years.  They had a much higher mortality rate.  One might expect an even higher rate as people age and their immune response drops off.  On the other hand I think there could remain a gap between people who are DX'ed and the un-dx'ed.  There may be a gap between those with HCV who drink and those who do not.

Interesting but hard to pin down meaning.  Maybe it will spawn a better study or it may be continued and yield more and better data than the article.

best,
Willy

[BelB64]

It's ridiculous for Vertex to say that "Everyone with Hep C" will eventually get cirrosis and die of the disease. The are approximately 3,000,000 + with Hep c in America alone. The estimates are that 10,000 die annually now and that number will triple over the next 5-10 years. That means it will take at least 100 years for everyone to die if noone else contracts the disease. The CDC still says that about 20-30% will get cirrhosis and that 3% will die. Still too many, but nowhere near 100%. Remember Vertex has a vested interest in getting people to treat They've made a great product, but they are still in the business of making a lot of money.

[Marc1955]

I don't think it means anything. They followed patients for two years. Those that were not cirrhotic or coinfected had no higher a mortality rate than the general population. Well, isn't that exactly what you would expect? If you are not cirrhotic, it's extremely unlikely you will die of liver disease within a two -year time frame. You need a much longer study to examine this issue.