Impact of Hepatitis C Status on 20-Year Mortality of Patients with Substance Use Disorders

The magnitude of the effect of hepatitis C viral infection on survival is still not fully understood. The objective of this study was to determine whether the presence of hepatitis C viral antibodies in 1991 was associated with increased mortality 20 years later within a cohort of patients with substance use disorders. Secondary objectives were to determine other factors that were associated with increased mortality in the cohort.

A subset of a 1991 study cohort of patients who had presented for detoxification was reexamined 20 years later. The Social Security Death Index was queried to identify which of the original patients had died. Attributes of survivors and non-survivors were compared, with special attention to their hepatitis C status in 1991. The original study and this analysis were conducted in the chemical detoxification unit at Johns Hopkins Bayview (previously Francis Scott Key Hospital), an academic urban hospital. All participants met the criteria for alcohol or opioid dependence at the time of admission in 1991. The primary study outcome was 20-year mortality after initial admission in 1991, with a planned analysis of hepatitis C status.

Twenty years after admission, 362 patients survived and 82 had died. Of the 284 patients who were hepatitis C positive, 228 survived (80 %). Of the 160 patients who were hepatitis C negative, 134 survived (84 %). This absolute risk increase of 4 % was not statistically significant (p = 0.37). Factors associated with increased mortality included male sex, white race, older age, and reported use of alcohol, cocaine, and illicit methadone. Binary logistic regression including hepatitis C status and these other variables yielded an adjusted odds ratio of 0.87 (95 % CI 0.49-1.55); (p = 0.64) for hepatitis C positive 20-year survival.

Hepatitis C positivity was not associated with a statistically significant difference in 20-year survival. The effect of the virus on mortality, if present, is small, relative to the effect of substance use disorders alone.

Below:  a Anti-HCV positivity did not confer a statistically significant 20-year mortality increase. b Comparison of deaths among IV drug users, compared to US General Population

Below:  Time to event analysis of mortality for hepatitis C positive and negative patients

Table 2
Mortality at 20 years, by subgroup
Demographic	Alive	Deceased	% deceased, %	P
Totals	362	82	18
Age mean, years	32.8	37.9		<0.0001
Gender
M	222	66	23
F	140	16	10	0.001
Race*
White	83	35	30
Black	278	47	14	0.001
Hx IDU
Yes	244	57	19
No	118	25	17	0.72
Drugs of abuse
Alcohol
Yes	237	63	21
No	125	19	13	0.05
Cocaine
Yes	263	52	17
No	99	30	23	0.1
Heroin
Yes	233	51	18
No	129	31	19	0.71
Methadone
Yes	27	12	31
No	335	70	17	0.04
Benzodiazepines
Yes	61	19	24
No	301	63	17	0.18
Marijuana
Yes	90	20	18
No	272	62	19	0.93
Hx STD
Yes	152	23	13
No	210	59	22	0.02
Hep C Ab
Positive	228	56	20
Negative	134	26	16	0.37
Hep BSAg
Positive	10	4	29
Negative	352	78	18	0.32
HepBSab
Positive	115	27	19
Negative	247	55	18	0.84
HIV
Positive	23	7	23
Negative*	339	74	18	0.46
RPR
Positive	23	29	56
Negative	339	415	55	0.75
AST
<31	210	39	16
>31 and <60	86	23	21	0.21
>60	66	20	23
ALT
<31	193	39	17
>31 and <60	91	23	20	0.64
>60	78	20	20

Accurso et al.

Accurso et al. Addiction Science & Clinical Practice 2015 10:20   doi:10.1186/s13722-015-0041-6

Full article at: http://goo.gl/IHwLlC

By: Accurso AJ1, Rastegar DA2, Ghazarian SR3, Fingerhood MI4.

• 1Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, Mason F. Lord Bldg, West Tower 5th floor, Baltimore, MD, 21224, USA. antaccurso@gmail.com.
• 2Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, Mason F. Lord Bldg, West Tower 5th floor, Baltimore, MD, 21224, USA. drasteg1@jhmi.edu.
• 3Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, Mason F. Lord Bldg, West Tower 5th floor, Baltimore, MD, 21224, USA. sghazarian@jhmi.edu.
• 4Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, Mason F. Lord Bldg, West Tower 5th floor, Baltimore, MD, 21224, USA. mifinger@jhmi.edu.

  

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