Increased rate of death related to presence of viremia among hepatitis C virus antibody–positive subjects in a community-based cohort study

Authors

  • Hirofumi Uto,

    Corresponding author
    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
    • Kagoshima University Graduate School of Medical and Dental Sciences, Department of Digestive Disease and Life-style related Disease Health Research, 8-35-1 Sakuragaoka, Kagoshima, Japan 890-8520
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    • fax: (81) 99-264-3504

  • Sherri O. Stuver,

    1. Department of Epidemiology, Boston University School of Public Health, Boston, MA
    2. Department of Epidemiology, Harvard School of Public Health, Boston, MA
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  • Katsuhiro Hayashi,

    1. Center for Medical Education, Faculty of Medicine, University of Miyazaki, Kiyotake, Japan
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  • Kotaro Kumagai,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Fumisato Sasaki,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Shuji Kanmura,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Masatsugu Numata,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Akihiro Moriuchi,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Susumu Hasegawa,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Makoto Oketani,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Akio Ido,

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Kazunori Kusumoto,

    1. Gastroenterology and Hematology, Faculty of Medicine, University of Miyazaki, Kiyotake, Japan
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  • Satoru Hasuike,

    1. Gastroenterology and Hematology, Faculty of Medicine, University of Miyazaki, Kiyotake, Japan
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  • Kenji Nagata,

    1. Gastroenterology and Hematology, Faculty of Medicine, University of Miyazaki, Kiyotake, Japan
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  • Michinori Kohara,

    1. Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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  • Hirohito Tsubouchi

    1. Department of Digestive and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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  • Potential conflict of interest: Nothing to report.

Abstract

The overall mortality of patients infected with hepatitis C virus (HCV) has not been fully elucidated. This study analyzed mortality in subjects positive for antibody to HCV (anti-HCV) in a community-based, prospective cohort study conducted in an HCV hyperendemic area of Japan. During a 10-year period beginning in 1995, 1125 anti–HCV-seropositive residents of Town C were enrolled into the study and were followed for mortality through 2005. Cause of death was assessed by death certificates. Subjects with detectable HCV core antigen (HCVcAg) or HCV RNA were considered as having hepatitis C viremia and were classified as HCV carriers; subjects who were negative for both HCVcAg and HCV RNA (i.e., viremia-negative) were considered as having had a prior HCV infection and were classified as HCV noncarriers. Among the anti–HCV-positive subjects included in the analysis, 758 (67.4%) were HCV carriers, and 367 were noncarriers. A total of 231 deaths occurred in these subjects over a mean follow-up of 8.2 years: 176 deaths in the HCV carrier group and 55 in the noncarrier group. The overall mortality rate was higher in HCV carriers than in noncarriers, adjusted for age and sex (hazard ratio, 1.53; 95% confidence interval, 1.13-2.07). Although liver-related deaths occurred more frequently among the HCV carriers (hazard ratio, 5.94; 95% confidence interval, 2.58-13.7), the rates of other causes of death did not differ between HCV carriers and noncarriers. Among HCV carriers, a higher level of HCVcAg (≥100 pg/mL) and persistently elevated alanine aminotransferase levels were important predictors of liver-related mortality. Conclusion: The presence of viremia increases the rate of mortality, primarily due to liver-related death, among anti–HCV-seropositive persons in Japan. (HEPATOLOGY 2009.)

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