Brian J McMahon1, Dana Bruden2, Lisa Townshend-Bulson3, Brenna Simons3, Phillip Spradling4, Stephen Livingston3, James Gove3, Annette Hewitt3, Julia Plotnik3, Chriss Homan3, Hannah Espera3, Susan Negus3, Mary Snowball3, Youssef Barbour3, Michael Bruce2, Prabhu Gounder2. 1. Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska; Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control, Anchorage, Alaska. Electronic address: bdm9@cdc.gov. 2. Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control, Anchorage, Alaska. 3. Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska. 4. Division of Viral Hepatitis, Centers for Human Immunodeficiency Virus, Tuberculosis Prevention, Sexually Transmitted Diseases, and Viral Hepatitis, Centers for Disease Control, Atlanta, Georgia.
Abstract
BACKGROUND & AIMS: Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection. METHODS: We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012. We calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for end-stage liver disease (ESLD; presence of ascites, esophageal varices, hepatic encephalopathy, or coagulopathy), hepatocellular carcinoma (HCC), and liver-related death using a Cox proportional hazards model. RESULTS: We enrolled 1080 participants followed up for 11,171 person-years (mean, 10.3 person-years); 66%, 19%, and 14% were infected with HCV genotypes 1, 2, and 3, respectively. On multivariate analysis, persons infected with HCV genotype 3 had a significantly increased risk of developing all 3 adverse outcomes. Their aHR for ESLD was 2.1 (95% CI, 1.5-3.0), their aHR for HCC was 3.1 (95% CI, 1.4-6.6), and their aHR for liver-related death was 2.4 (95% CI, 1.5-4.0) compared with genotype 1. Heavy alcohol use was an age-adjusted risk factor for ESLD (aHR, 2.2; 95% CI, 1.6-3.2), and liver-related death (aHR, 2.9; 95% CI, 1.8-4.6). Obesity was a risk factor for ESLD (aHR, 1.4; 95% CI, 1.0-1.9), and diabetes was a risk factor for ESLD (aHR, 1.5; 95% CI, 1.1-2.2). Male sex was a risk factor for HCC (aHR, 3.6; 95% CI, 1.6-8.2). CONCLUSIONS: In a population-based cohort study of American Indian/Alaska Native persons with chronic HCV infection, we found those infected with HCV genotype 3 to be at high risk for ESLD, HCC, and liver-related death.
BACKGROUND & AIMS: Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection. METHODS: We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012. We calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for end-stage liver disease (ESLD; presence of ascites, esophageal varices, hepatic encephalopathy, or coagulopathy), hepatocellular carcinoma (HCC), and liver-related death using a Cox proportional hazards model. RESULTS: We enrolled 1080 participants followed up for 11,171 person-years (mean, 10.3 person-years); 66%, 19%, and 14% were infected with HCV genotypes 1, 2, and 3, respectively. On multivariate analysis, persons infected with HCV genotype 3 had a significantly increased risk of developing all 3 adverse outcomes. Their aHR for ESLD was 2.1 (95% CI, 1.5-3.0), their aHR for HCC was 3.1 (95% CI, 1.4-6.6), and their aHR for liver-related death was 2.4 (95% CI, 1.5-4.0) compared with genotype 1. Heavy alcohol use was an age-adjusted risk factor for ESLD (aHR, 2.2; 95% CI, 1.6-3.2), and liver-related death (aHR, 2.9; 95% CI, 1.8-4.6). Obesity was a risk factor for ESLD (aHR, 1.4; 95% CI, 1.0-1.9), and diabetes was a risk factor for ESLD (aHR, 1.5; 95% CI, 1.1-2.2). Male sex was a risk factor for HCC (aHR, 3.6; 95% CI, 1.6-8.2). CONCLUSIONS: In a population-based cohort study of American Indian/Alaska Native persons with chronic HCV infection, we found those infected with HCV genotype 3 to be at high risk for ESLD, HCC, and liver-related death.
Authors: M J Alter; D Kruszon-Moran; O V Nainan; G M McQuillan; F Gao; L A Moyer; R A Kaslow; H S Margolis Journal: N Engl J Med Date: 1999-08-19 Impact factor: 91.245
Authors: Stephen E Livingston; Heike Deubner; Dana L Bruden; Brian J McMahon; Chriss E Homan; Lisa J Townshend-Bulson; Michael G Bruce; Thomas W Hennessy; James L Williams; David R Gretch Journal: Can J Gastroenterol Date: 2010-07 Impact factor: 3.522
Authors: Kathleen N Ly; Jian Xing; R Monina Klevens; Ruth B Jiles; John W Ward; Scott D Holmberg Journal: Ann Intern Med Date: 2012-02-21 Impact factor: 25.391
Authors: Brian J McMahon; Dana Bruden; Michael G Bruce; Stephen Livingston; Carol Christensen; Chriss Homan; Thomas W Hennessy; James Williams; Daniel Sullivan; Hugo R Rosen; David Gretch Journal: Gastroenterology Date: 2009-11-10 Impact factor: 22.682
Authors: Brian J McMahon; Thomas W Hennessy; Carol Christensen; Dana Bruden; Daniel G Sullivan; Chriss Homan; Heike Deubner; Michael G Bruce; Stephen Livingston; James Williams; David R Gretch Journal: Hepatology Date: 2004-02 Impact factor: 17.425
Authors: Brian J McMahon; Lisa Bulkow; Brenna Simons; Yuhong Zhang; Susan Negus; Chriss Homan; Philip Spradling; Eyasu Teshale; Daryl Lau; Mary Snowball; Stephen E Livingston Journal: Clin Gastroenterol Hepatol Date: 2013-09-11 Impact factor: 11.382
Authors: Stephen E Livingston; Lisa J Townshend-Bulson; Dana J T Bruden; Chriss E Homan; James E Gove; Julia N Plotnik; Brenna C Simons; Philip R Spradling; Brian J McMahon Journal: Int J Circumpolar Health Date: 2016-03-29 Impact factor: 1.228
Authors: Brigg Reilley; Jessica Leston; Mona Doshani; Dana L Haberling; Marissa Person; Thomas Weiser; Melissa Collier; Jonathan Iralu; Jorge Mera; Rick Haverkate Journal: J Community Health Date: 2018-12
Authors: Brian J Mcmahon; Lisa Townshend-Bulson; Chriss Homan; Prabhu Gounder; Youssef Barbour; Annette Hewitt; Dana Bruden; Hannah Espera; Julia Plotnik; James Gove; Timothy J Stevenson; Sarah V Luna; Brenna C Simons Journal: Clin Infect Dis Date: 2020-04-15 Impact factor: 9.079
Authors: Hye Kyong Park; Sang Soo Lee; Chang Bin Im; Changjo Im; Ra Ri Cha; Wan Soo Kim; Hyun Chin Cho; Jae Min Lee; Hyun Jin Kim; Tae Hyo Kim; Woon Tae Jung; Ok-Jae Lee Journal: BMC Cancer Date: 2019-08-20 Impact factor: 4.430
Authors: Fausto Petrelli; Alessio Cortellini; Alice Indini; Gianluca Tomasello; Michele Ghidini; Olga Nigro; Massimiliano Salati; Lorenzo Dottorini; Alessandro Iaculli; Antonio Varricchio; Valentina Rampulla; Sandro Barni; Mary Cabiddu; Antonio Bossi; Antonio Ghidini; Alberto Zaniboni Journal: JAMA Netw Open Date: 2021-03-01