美國因為C肝死亡人數比因為HIV死亡者更多

Hepatitis
C Linked to More Deaths Than HIV

Yael Waknine

February 21, 2012 —
Hepatitis C viral infection (HCV) has surpassed HIV as a cause of mortality in
the United States, according to a new study from the US Centers for Disease
Control and Prevention (CDC), published
in the February 21 issue of the Annals
of Internal Medicine.

Termed the
"silent epidemic," HCV is the most common blood-borne chronic viral
infection. It affects about 3.2 million Americans and represents a leading
cause of liver disease, cirrhosis, and death.

Using death
certificate data from about 22 million decedents from between 1999 and 2007,
investigators found that recorded deaths from HCV increased significantly,
whereas those linked to HBV remained constant, and HIV-associated mortality
decreased.

Almost 75% of
HCV-related deaths occurred among baby boomers (individuals born between 1945
and 1964), who may have experimented with substances in their youth. Many are
unaware of the infection, suggesting that the burden of disease will continue
to rise unless policies for education, detection, and treatment are implemented
in a manner similar to that used during the HIV epidemic.

"The decrease in
deaths from HIV infection in the past decades reflects the availability and
utilization of highly effective therapies, as well as effective national
implementation of programs for prevention and care," write Kathleen N. Ly,
MPH, from the Division of Viral Hepatitis, CDC, Atlanta, Georgia, and
colleagues, noting that a similar approach to HCV might lead to similar
reductions in mortality over time.

HCV Mortality Rate
Exceeds That of HIV

For the study,
investigators analyzed data from about 21.8 million death certificates (~2.4
million/year between 1999 and 2007) and found a significant increase in annual
age-adjusted mortality rate resulting from HCV (0.18 deaths per 100,000
individuals; P =
.002).

In contrast, the
annual age-adjusted mortality rate for HBV-related deaths remained relatively
constant, decreasing slightly by 0.02 deaths/100,000 individuals (P = 0.25), whereas that
for deaths related to HIV infection decreased significantly by 0.21
deaths/100,000 individuals (P
= .001).

By 2007, HCV
infection was linked to an age-adjusted mortality rate significantly higher
than that of HIV (4.58 deaths/100,000 individuals [95% confidence interval
(CI), 4.50 - 4.67 deaths/100,000 individuals] vs 4.16 deaths/100,000
individuals [95% CI, 4.09 - 4.24 deaths/100,000 individuals]; actual deaths,
15,106 vs 12,734).

Moreover, the
greatest proportion of HCV-related deaths occurred among baby boomers aged 45
to 64 years (73.4%). Frequently reported comorbid conditions included chronic
liver disease (adjusted odds ratio [OR], 32.1; 95% CI, 31.0 - 33.3) and HBV
coinfection (adjusted OR, 29.9; 95% CI, 26.5 - 33.6), followed by
alcohol-related conditions (adjusted OR, 4.6; 95% CI, 4.4 - 4.8) and HIV
infection (adjusted OR, 1.8; 95% CI, 1.6 - 2.0).

Though frightening,
the data represent a fraction of the burden of disease and death associated
with HCV, the authors write, noting that only 40% to 50% of infected
individuals would have been diagnosed at the time of death. Left unaddressed,
HCV-related mortality will only increase as the baby-boomer generation ages,
they add.

Identification of
Asymptomatic HCV Is Key

"It is estimated
that 50% to 75% of persons with HCV are unaware of their HCV status," note
Harvey J. Alter, MD, and T. Jake Liang, MD, from the National Institutes of
Health in Bethesda, Maryland, in an accompanying
editorial, noting that most are not addicts but simply people who
experimented with drugs for a limited time in their youth.

The good news is that
treatments for HCV are evolving so quickly that 5 years from now, interferon-free,
oral, direct-acting antiviral regimens may achieve cure rates approaching 90%
irrespective of viral genotypes and IL-28B status.

"What is
currently lacking in this optimistic perspective is a national 'find-and-treat'
policy aimed at achieving maximum identification of HCV carriers and providing
new-generation therapies to a large proportion of those identified cases,"
Dr. Alter and Dr. Liang note.

Chronic Liver Disease
Foundation Recommends New Screening Measures

The CDC currently
recommends HCV screening only for people found to be at risk for infection, but
it is evaluating the potential benefits of using a birth cohort based approach
to HCV screening to help increase identification of HCV-positive patients.

The Chronic Liver
Disease Foundation is supportive of the concept and has issued the following
recommendations in support of the expansion of HCV screening efforts:

• Routine
  screening for HCV among individuals born between 1945 and 1965.


• Use
  of the OraQuick (OraSure) HCV rapid point-of-care test to expand testing
  opportunities and facilitate immediate care.


• Educational
  programs aimed at primary care providers to increase awareness of HCV risk
  factors.


• Testing
  for HCV in primary care setting with established linkages to HCV.


• Creative
  ways to increase access to HCV testing and care for injection-drug users
  and other underserved populations.

Support for this
study was provided by the Centers for Disease Control and Prevention. The
authors have disclosed no relevant financial relationships.

Ann Intern Med. 2012;156:271-278,
317-318. Article abstract, Editorial
extract

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Medical News © 2012 WebMD, LLC