In the US, Deaths from HCV Now Exceed Those from HIV

Given that most individuals with hepatitis C virus (HCV) are middle-aged, and complications of HCV (e.g., cirrhosis, liver cancer) are known to occur after decades of infection, prior researchers hypothesized an increase in HCV-related mortality over time. This study examined US mortality rates for HCV and hepatitis B virus (HBV) from 1999–2007 and contrasted those trends with those for HIV. Death certificates from all US states and the District of Columbia were included in the analysis. Age-adjusted mortality rates were calculated using Poisson distribution.

• For HCV, the average annual age-adjusted mortality rate increased by 0.18 deaths per 100,000 persons per year (p=0.002), while the age-adjusted mortality rate for HBV remained relatively constant over time.

• For HIV, the average annual age-adjusted mortality rate decreased by 0.21 deaths per 100,000 persons per year (p=0.001).

• Before 2007, the number of deaths from HIV exceeded those from HCV and HBV. After 2007, the number of deaths from HCV (15,106) exceeded those from HIV (12,734) and HBV (1815).

• Most deaths from HCV were among people aged 45–65, with alcohol being the third most common comorbid condition for deaths from HCV (after chronic liver disease and HBV coinfection).

Comments:

As of 2007, HCV superseded HIV as a cause of death in the US. Alcohol is an important co-factor for many HCV-related deaths, and injection drug use is a major risk factor for contracting HCV. Use of death-certificate data for cause of death was a limitation in this study; however, this is less of problem when analyzing trends since biases should be relatively constant over time.

Judith Tsui, MD, MPH

Reference:

Ly KN, Xing J, Klevens RM. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;156(4): 271–278.