HCV-Related Complications Increasing among Women Veterans
BACKGROUND:
Chronic hepatitis C virus (HCV) infection is a progressive condition and the most common cause of cirrhosis, hepatocellular cancer (HCC), and liver disease deaths in the United States. However, there are gender-related variations in the epidemiology and clinical course of HCV infection. For example, men are at least 1.7 times more likely to be infected with HCV than women. Among individuals with chronic HCV, men also are at a higher risk of progression to advanced hepatic fibrosis, cirrhosis, and decompensated liver disease (deterioration in liver function) than women. The prevalence of liver-related sequelae of chronic HCV has been increasing in recent years, in parallel with the aging of the chronically infected HCV cohort in this country. Yet it is unknown if the burden of HCV-related complications differs between women and men. This observational retrospective study examined gender-related differences in the incidence and prevalence of cirrhosis, decompensated cirrhosis, and HCC between 2000 and 2013. Using VA data, investigators identified all Veterans with HCV from January 2000 through December 2013 (n=257,247 men and 7,162 women).
FINDINGS:
- The incidence and prevalence of HCV complications was higher in men than in women. However, the rate of increase in the incidence rates of cirrhosis and decompensated cirrhosis among HCV-infected women is similar to the rate of increase in men.
- The annual prevalence of cirrhosis was significantly higher in men vs. women for all study years. In 2000, 3% of women vs. 5% of men had been diagnosed with cirrhosis. By 2013, the prevalence for cirrhosis had risen to 14% and 21% in women vs. men, respectively.
- Temporal trends in the prevalence of decompensated cirrhosis mirrored those observed for cirrhosis. In 2000, the prevalence of decompensated cirrhosis was 1.6% in women and 2.4% in men, but increased by 2013 to 7% in women and 12% in men.
- HCC prevalence was higher in men than in women across all years. Over the study years, HCC prevalence remained relatively constant for women (0% in 2000 to 0.7% in 2013), but increased from 0.1% to 2.5% in 2013 in men.
IMPLICATIONS:
- The increase in cirrhosis complications in women with active HCV infection is similar to those in men. With cure from HCV becoming a reality, most of the projected burden of HCV is potentially preventable. However, the benefits of HCV treatment must be extended to all patients in order to stem the rising tide of HCV complications.
LIMITATIONS:
- Several unmeasured patient characteristics could have affected the study results. For example, although investigators had information on antiviral treatment, they opted not to include this variable in their analysis given similar treatment rates in the two study groups – and the low efficacy of previous interferon-based treatment used during the study time frame.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 13-059). Drs. Kramer and El-Serag are part of HSR&D's Center for Innovations in Quality, Effectiveness, and Safety.
Kramer J, El-Serag H, Taylor T, et al. Hepatitis C virus-Related Complications are Increasing in Women Veterans: A National Cohort Study. Journal of Viral Hepatitis. November 2017;24(11):955-65.
