Undetectable Viral Load Associated with Decreased Illness, Death in Patients with Hepatitis C

In a study of Veterans Affairs patients with hepatitis C (HCV), only a minority were willing to start treatment and fewer still achieved the undetectable viral loads that appear to be associated with decreased rates of illness and death, according to a study published by JAMA Internal Medicine, a JAMA Network publication.

HCV is estimated to affect as many as 170 million people worldwide and an estimated 3.2 million people in the United States. Patients with HCV are at risk of developing liver-related complications such as cirrhosis, liver failure and the cancer hepatocellular carcinoma (HCC), the authors write in the study background. However, sometimes patients with HCV go untreated because of adverse effects from available treatments.

Jeffrey McCombs, Ph.D., of the University of Southern California School of Pharmacy, Los Angeles, and colleagues sought to describe the progression of HCV in clinical practice by examining the time to liver-related clinical events and death in a group of 28,769 patients from the Veterans Affairs (VA) HCV clinical registry.

Of the patients, only 24.3 percent were willing to start treatment, and 16.4 percent of treated patients achieved an undetectable viral load. The study reports that death rates were 6.8 per 1,000 person-years for patients who achieved viral suppression vs. 21.8 per 1,000 person-years in patients who did not meet that goal. Patients who achieved undetectable viral loads also reduced their risk of liver-related events by 27 percent, according to the results.

“While antiviral therapy can lead to viral eradication and reduced event risk, its effectiveness under real-world clinical conditions is limited by adverse effects and other factors. In this study, only 1 in 4 patients with HCV and a detectable viral load were willing to initiate treatment. Once treated, only a fraction of patients achieved the minimum treatment response of a single undetectable viral load test,” the authors write.

In a related editor’s note, Mitchell Katz, M.D., a JAMA Internal Medicine deputy editor, writes: “The authors demonstrate that patients who do achieve viral suppression, which almost always required treatment, fared significantly better. The critical issue going forward is whether the new drugs that have been released (e.g. hepatitis C protease inhibitors) or are likely to be approved soon (e.g. hepatitis C nucleotide polymerase inhibitor) can achieve sustained viral suppression in a high percentage of patients without serious adverse effects. And can these treatments be made available without breaking the bank of safety net health systems across the country that care for large numbers of patients with hepatitis C? I certainly hope so.”

(JAMA Intern Med. Published online November 5, 2013. doi:10.1001/jamainternmed.2013.12505.