Chronic Liver Disease: A Mixed Picture on Prognosis

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Direct-acting antiviral drugs have revolutionized the treatment of people with viral hepatitis, reducing the death rate markedly. At the same time, deaths from complications outside the liver (extrahepatic)—such as cancers, cardiovascular disease, and diabetes—have increased.

To assess trends in deaths associated with viral hepatitis, alcoholic liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD) before and after the widespread use of direct-acting antivirals, researchers analyzed national data from 2007 to 2017.

They found that liver-related deaths in adults with hepatitis C virus (HCV) and hepatitis B virus (HBV), which had been rising since the study’s start, decreased from 2014 to 2017. But deaths due to cardiovascular disease and diabetes increased steadily in people with HCV. The rate of cancer-related deaths in people with hepatitis B and C increased significantly from 2007 to 2014, at which point it plateaued. This suggests that hepatitis viruses are responsible for inducing extrahepatic illnesses. Eradication of the viruses will likely decrease the risk of developing some of the extrahepatic diseases. In people with ALD and NAFLD, cancer-related mortality increased.

The findings, which were published in 2019 in Gastroenterology, suggest that while people with chronic viral infections may enjoy increased longevity due to better drug treatments, they are still vulnerable to nonliver-related diseases and should be closely monitored for extrahepatic complications.