HCV-related liver disease on the rise in women

Hepatitis C virus (HCV)-related complications are increasing among women, according to a national cohort study.

Typically, men have a higher risk of progression to liver disease than women because men develop liver disease from HCV at a higher rate than women.

“We found that women had increase of incidence of liver disease at a similar rate to men.  Since the mortality rate was lower in women, this suggests that women will have a larger contribution to the overall burden of liver disease in future years,” lead author Jennifer R. Kramer, PhD, investigator with the Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center and Department of Medicine in Houston, Texas, told Medical Economics.

The researchers published their results October 12, 2017 in the Journal of Viral Hepatitis.

Kramer, who is also an assistant professor with the Section of Medicine-Health Services Research at Baylor College of Medicine in Houston, and colleagues used Veterans Administration data to identify veterans with positive HCV viremia from January 2000 to December 2013. They calculated the gender-specific annual incidence and prevalence rates of cirrhosis, decompensated cirrhosis and hepatocellular cancer (HCC) adjusting for age, diabetes, HIV and alcohol use.  Of the 264,409 HCV-infected veterans, 7,162 (2.7%) were women.

The researchers found statistically significant increases over time in the incidence rates of cirrhosis, decompensated cirrhosis and HCC for both men and women. The annual-adjusted incidence rates of cirrhosis, decompensated cirrhosis and HCC were higher in men than women, however, these complications increased at a similar rate in both groups.

“We had thought that perhaps the increase would be greater in women in recent years due to having a slower progression of liver disease and being infected later in the epidemic, but we did not see that,” said Kramer.

Next: The importance of testing

She noted the lag time between HCV infection and liver injury has led to the recent increase in liver disease diagnosis. “Also, due to increased awareness of screening for HCV due to improved treatment alternatives, more women are being diagnosed, but access to treatment might be an issue. In the past women have been less likely to receive treatment than men and this could impact the increasing liver disease rates in women,” said Kramer.

The results highlight the rising burden of HCV in women and importance of educating primary care physicians about the long-term health effects of HCV. “It’s important to test patients in the baby boomer birth cohort, not just patients with high-risk lifestyles,” said Kramer.

She also suggested that specialty and internal medicine professional societies can encourage primary care physicians to test and treat HCV in both men and women. “Primary care physicians need access to information about how to obtain treatment for patients with no insurance coverage, or who have minimal coverage insurance plans, for example, more information on HCV support networks, and non-profits in their geographic area that offer to help patients obtain treatment at lower or no cost,” said Kramer.

Kramer added: “With cure from HCV now becoming a reality, most of the projected burden of HCV is potentially preventable. With the availability of multiple proven treatment options for chronic HCV infection, there must be an increased focus on screening and treating patients with this disease.”