Rates of Liver Cancer and Cirrhosis Increase Significantly among Veterans with Hepatitis C Virus
BACKGROUND:
Patients with hepatitis C virus (HCV) infection are at risk for developing additional liver disorders (i.e., cirrhosis) that are costly to treat and have high rates of morbidity, although the actual prevalence of these complications is not known. The VA healthcare system has a disproportionate number of patients with HCV, which makes it a “flagship” healthcare system in which to examine changes in the burden of cirrhosis. This retrospective cohort study used VA data to identify all Veterans with HCV who visited any of 128 VA medical centers between 1/96 and 12/06. The primary outcomes were time trends in the prevalence of cirrhosis, hepatic decompensation, and hepatocellular cancer (HCC). Investigators also examined the following risk factors that may be associated with an accelerated progression to cirrhosis: age, race, HIV infection, hepatitis B virus infection, diabetes, and alcohol use.
FINDINGS:
- The number of Veterans diagnosed with HCV increased from 17,261 in 1996 to 106,242 in 2006. Over the same time period, among HCV patients, the prevalence of cirrhosis increased from 9% to 18.5%, while the prevalence of HCC increased approximately 19-fold (from 0.07% to 1.3%).
- Regarding risk factors among HCV-infected Veterans, the proportion of patients with co-existing diabetes increased from 12% in 1996 to 23% in 2006, while the number of patients with HIV, hepatitis B virus, or a diagnosis of alcohol use declined slightly.
- After adjusting for aging, time trends remained significantly upward, suggesting that other “unmeasured” factors associated with the passage of time (i.e., duration of HCV infection) have a role in the rising burden of cirrhosis and related complications among Veterans with HCV.
LIMITATIONS:
- This study was not designed to identify causative elements that lead to the progression of liver disease; thus, investigators cannot imply causative relationships about progression from this study.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 07-111). Dr. Kanwal is part of the St. Louis VA Medical Center. Dr. Kramer is supported by an HSR&D Career Development Award and is part of HSR&D’s Houston Center for Quality of Care and Utilization Studies.
Kanwal F, Hoang T, Kramer J, Asch S, Goetz M, Zeringue A, Richardson P, El-Serag H. Increasing Prevalence of HCC and Cirrhosis in Patients with Chronic Hepatitis C Virus Infection. Gastroenterology December 22, 2010; e-pub ahead of print.
