[英语分析]Causes of Death Among People with Hepatitis B and C

StephenW

Causes  of Death Among People with Hepatitis B and C
              
              

SUMMARY                                           Deaths due to most liver-related causes dropped among people                   with hepatitis B, and people with hepatitis C were less likely                     to die of drug-related causes, but mortality due to hepatocellular                 carcinoma remained stable, according to a large Australian                     study. Coinfection with HIV increased mortality significantly.

              

By James Learned

              

Over  time chronic hepatitis B virus (HBV)   and hepatitis C virus (HCV) infection               can progress to advanced liver disease, including life-threatening liver failure and hepatocellular carcinoma (HCC), a form of liver cancer. These viruses are often transmitted through shared drug   injection equipment and people with hepatitis B and C are therefore  also at elevated risk for death due to drug-related causes such         as overdose.

              

In a retrospective study described in the May11, 2011, Journal of Hepatology, Scott Walter and colleagues     analyzed specific causes of death among a population-based cohort  of people with hepatitis B or C to examine trends in mortality and identify areas of excess risk.

The   study authors looked at medical records of people with hepatitis  B or C in New South Wales, Australia, between 1992 and 2006. New South Wales is the most populous state in Australia, including  almost one-third of the country's population.
              

Using data from the state's Notifiable Diseases Database, the researchers determined trends in mortality among people with HBV monoinfection,   HCV monoinfection, HBV/HCV coinfection, HIV/HBV  coinfection, HIV/HCV  coinfection, and HIV/HBV/HCV triple infection. Australia law   mandates reporting of HIV, HBV, and HCV diagnoses, allowing the   opportunity to conduct an accurate population-based assessment  of people living with these diseases.
A previous population-based study found large increases in rates of death among people with hepatitis B and an alarmingly jump in mortality among people with hepatitis C. The high HCV-related mortality was largely attributed to deaths due to drug-related causes, outnumbering deaths caused by liver disease. In the current  study, the researchers extended their previous work to examine recent trends in HBV- and HCV-related deaths, including the impact of coinfection.
               
                The study looked at medical records of 128,726 patients:
              

	82,034                     people (63.7%) with HCV monoinfection;
	42,480                     people (33%) with HBV monoinfection;
	3285                        people (2.6%) with HBV/HCV coinfection;
	269                          people (0.2%) with HIV/HBV coinfection;
	620                         people (0.5%) with HIV/HCV coinfection; and
	38                           people (< 0.1%) with HIV/HBV/HCV triple infection.

The  cohort included 60% men and 40% women; 90% of people with HIV  were men, and 72% of those coinfected with HBV/HCV were men. All  patients had been diagnosed with viral hepatitis between 1994               and 2002. If an individual died within 6 months of diagnosis, he or she was excluded from the analysis (1367 people).

StephenW

Results                 
              

	A   total of 6201 people died between 1992 and 2006, with mortality rates differing widely across groups:
	HCV monoinfection: 6%; HBV                           monoinfection: 3%; HBV/HCV                           coinfection: 7%; HIV/HBV                           coinfection: 23%; HIV/HCV                           coinfection: 15%.
	The  leading cause of death for the HBV monoinfected group was  neoplasms (tumors), most frequently HCC, followed by lung  cancer and lymphoid cancer.
	Cancer  rates were significantly higher among people with HBV monoinfection  than among those with HCV monoinfection.
	People  with HBV were significantly more likely to have HCC than those   with HCV.
	In  contrast, the leading cause of death in the HCV monoinfected group was not specifically liver-related -- 72% of deaths  were the result of drug overdose or suicide.
	The rate of all-cause mortality was significantly higher for the HCV monoinfected group than for the HBV monoinfected group.
	After taking into account age and sex, people with HCV monoinfection had a 2.5 times higher mortality rate compared with the overall population of New South Wales.
	However, the number of drug-related deaths among people with HCV in 2002 was approximately half that seen prior to 2000, and rates have since remained low and stable.
	Drug-related deaths of people with HCV during 2002-2006 were significantly lower than those reported during 1997-2001.
	For women with HBV or HCV, the risks of death due to drug-related causes and, significantly, liver disease, was higher than it was for men.
	Rates of liver-related death increased with age in both the HBV  monoinfected and HCV monoinfected groups.
	Among people with HBV/HCV coinfection, rates of all-cause death were considerably higher than among people with HBV or HCV monoinfection.
	Compared  with the overall population of New South Wales, the mortality rate for people with coinfection (HBV/HCV, HIV/HBV, or HIV/HCV)  was 4 to 24 times higher.
	People coinfected with HIV also had a markedly higher risk of death  compared to other infected groups.
	]People with HIV/HBV coinfection had a mortality rate 10 times  higher than those with HBV monoinfection. People with HIV/HCV coinfection were at least 3 times more likely to die than their HCV monoinfected counterparts.
	Most deaths among HIV/HBV and HIV/HCV coinfected people were HIV-related  (70% and 61%, respectively).
	People with HIV/HBV/HCV triple infection had by far the highest rate of death due to all causes.

In  their discussion of their analysis, the researchers described   the supply and purity of opiates that contributed to drug-related deaths, specifically the shortage and higher price of heroin in  late 2000 and early 2001. The decrease in the supply of heroin and its high price has been credited with fewer drug-related deaths during that period. However, the researchers noted, "[O]ur study found that rather than return to pre-2001 levels, rates           of drug-related deaths have remained low in 2002 to 2006."                 
"Wider  reaching interventions such as the needle and syringe exchange   programs (NSPs) and harm reduction campaigns delivered through the NSPs may also have contributed to the maintenance of improved    drug-related mortality since 2001 among those infected with HCV,"  they continued.
In   addition, they wrote, "The moderate decline in non-HCC liver   disease mortality among people with HBV monoinfection and the decline in age-specific rates of liver-related death with younger  cohorts suggest that improved HBV antiviral therapy may have reduced  the risk of death from decompensated cirrhosis."
The  authors suggested that the availability of antiviral drugs for  the treatment of hepatitis B may also have contributed to a decrease in hepatocellular carcinoma, although this did not reach statistical    significance. "The study identified a positive trend in non-HCC liver-related deaths among those infected with HBV, consistent        with improvements in HBV treatment and uptake."
Unfortunately, pegylated interferon was only licensed in Australia in 2006, so most people with hepatitis C were either not on treatment or on  thrice-weekly conventional interferon plus ribavirin. Lack of  the latest state-of-the-art treatment -- which now includes direct-acting antiviral agents as well as pegylated interferon/ribavirin --   may have contributed to the high rate of death among people with HCV.
Investigator   affiliations: National Centre in HIV Epidemiology and Clinical  Research, The University of New South Wales, Sydney, Australia; New South Wales Department of Health, Sydney, Australia; Storr  Liver Unit, Westmead Hospital and Westmead Millennium Institute, University of Sydney, Sydney, Australia; Australian Government  Department of Health and Ageing; NSW Cancer Council STREP Grant   (SRP08-03).
6/17/11
Reference
S   Walter, H Thein, J Amin, et al. Trends in mortality after diagnosis  of hepatitis B or C infection: 1992-2006. Journal of Hepatology  54(5):879-886 (abstract).  May 2011.

StephenW

乙型和丙型肝炎的人的死亡原因
概要

乙肝的人之间由于大多数肝有关死亡的原因下降了，并与C型肝炎的人不太可能死于与毒品有关的原因，但由于肝癌死亡率保持稳定，根据大澳的研究。合并感染艾滋病毒的死亡率上升明显。

由詹姆斯据悉

随着时间的推移慢性乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染可发展到晚期肝病，包括危及生命的肝衰竭和肝细胞癌（HCC），对肝癌的形成。这些病毒通常是通过共用注射毒品传播设备和乙型和丙型肝炎的人，因此在死亡原因，如过量药物有关的原因的风险也升高。

在肝脏病杂志，沃尔特斯科特和他的同事2011年5月11日，日记描述了一个回顾性研究中分析了与乙型或丙型肝炎的人的死亡率趋势，研究和确定的额外风险地区的人口为基础的队列死亡的具体原因。

这项研究的作者研究了B型或C型肝炎在新南威尔士，澳大利亚，1992年至2006年的医疗记录。新南威尔士州是澳大利亚人口最多的国家，几乎包括了全国人口的三分之一。

从国家使用的数据库法定传染病数据，研究人员确定其中乙肝病毒单感染，HCV 单感染，HBV / HCV合并感染，HIV / HBV合并感染，HIV / HCV合并感染和艾滋病毒/ HBV / HCV三重感染者死亡率趋势。澳大利亚法律规定报告的艾滋病毒，乙肝病毒，丙肝病毒和诊断，从而有机会进行准确的人口为基础的生活与这些疾病的人进行评估。

先前的人口为基础的研究中发现乙肝和惊人的死亡率之间跳跃与C型肝炎高HCV相关的死亡率主要是由于人死于与毒品有关的人引起了人们的死亡率大幅增加，数量上超过死亡引起肝病。在目前的研究中，研究人员延长他们以前的工作，研究最近的趋势在HBV和HCV相关的死亡，其中包括合并感染的影响。

这项研究在对128726例病历：
82034人（63.7％）与丙型肝炎病毒 单感染;
42480人（33％）与HBV 单感染;
3285人（2.6％）与HBV / HCV合并感染;
269​​人（0.2％）与HIV / HBV合并感染;
620人（0.5％）与HIV / HCV合并感染;和
38人（<0.1％）与HIV / HBV / HCV三重感染。

该组包​​括60％为男性，40％为女性，90％的艾滋病毒感染者为男性，和72那些HBV / HCV合并感染％为男性。所有患者已被确诊为1994年至2002年病毒性肝炎。如果一个人在6个月内死亡的诊断，他或她被排除在分析（1367人）。

结果
一共有6201人死于1992年至2006年，死亡率在不同群体广泛率：
HCV 单感染：6％;
HBV 单感染：3％;
HBV / HCV合并感染：7％;
HIV / HBV合并感染：23％;
HIV / HCV合并感染：15％。
对死亡的乙型肝炎病毒 单感染组的原因是肿瘤（肿瘤），最常见的肝癌，肺癌和淋巴癌症之后。
癌症发病率显着高于乙肝 单感染之间的人比那些中丙型肝炎病毒单感染。
乙肝病毒的人明显更可能比那些有HCV肝癌。
相比之下，在死亡的首要原因是HCV 单感染d组没有特别肝脏相关 - 72％的死亡是药物过量或自杀的结果。
对各种原因的死亡率显着的高于HCV 单感染组的HBV 单感染组。
在考虑年龄和性别考虑，丙型肝炎病毒单感染n人有2.5倍的死亡率相比，新南威尔士总人口。
然而，与丙型肝炎病毒的人当中，2002年与毒品有关的死亡人数约一半，可见2000年以前，差饷以来保持低而稳定。
与丙型肝炎病毒的人在2002-2006年与毒品有关的死亡人数均显着高于1997-2001年期间报告的低。
对于有HBV或HCV，死亡因与毒品有关的风险和原因，重要的是，肝脏疾病的妇女，高于它是男性。
肝相关死亡率随着年龄的增加同时在HBV和HCV 单感染组。
在与HBV / HCV合并感染的人，各种原因的死亡率大大高于中与HBV或HCV 单感染人高。
相对于新南威尔士，同时感染人与整体人口死亡率（HBV / HCV，HIV / HBV或HIV / HCV）为4至24倍。
合并感染艾滋病毒的人也有其它的死亡相比，感染组显着较高的风险。
与HIV / HBV合并感染的人的死亡率进行了10倍，比乙肝病毒单感染高。
与HIV / HCV合并感染的人至少有3倍更有可能死于丙肝单感染比他们的同行。
在HIV / HBV和HIV / HCV合并感染的人多数死亡与艾滋病毒有关（70％和61％，分别）。
与HIV / HBV / HCV三重感染者已到目前为止，由于各种原因导致的死亡比例最高。

在他们的分析讨论，研究人员描述了阿片类药物促成毒品有关的死亡，特别是短缺和较高的海洛因的价格在2000年底和2001年初的供应和纯洁性。在海洛因和其高昂的价格供应减少已记入较少的药物有关的死亡在此期间。不过，研究人员指出，“[O] UR研究发现，而不是回到2001年以前的水平，与毒品有关的死亡率一直保持在2002年至2006年低。”

“如针头和注射器交换方案（的NSP）和减少伤害的NSP传递活动，通过广泛深远的干预也可能助长了改进与毒品有关的死亡率自2001年以来中丙型肝炎病毒感染者的维护，”他们继续。

此外，他们写道，“在非肝癌肝病的死亡率和乙肝病毒单感染n在肝脏有关的死亡年龄别率与年轻世代decline人略有下降表明，改进的HBV抗病毒治疗可减少风险从失代偿性肝硬化死亡。“

作者建议，为治疗乙肝抗病毒药物的供应情况可能也促成了肝癌减少，虽然这并没有达到统计学意义。 “这项研究确定了在非肝癌肝相关的HBV感染者中有死亡的积极趋势，在乙肝病毒治疗和摄取改善是一致的。”

不幸的是，聚乙二醇干扰素仅在2006年获准在澳大利亚，所以C型肝炎大多数人要么接受治疗或每周三班常规干扰素加利巴韦林没有。缺乏最新的先进设备，最先进的治疗 - 现在包括直接作用抗病毒药物以及聚乙二醇干扰素/利巴韦林 - 可能造成的死亡的丙型肝炎病毒率很高。

调查背景：国家大剧院在艾滋病流行病学和临床研究，新南威尔士，澳大利亚悉尼大学，新南威尔士卫生署，澳大利亚悉尼; Storr 肝区，Westmead 医院和韦斯特米德千年研究所，悉尼大学，悉尼，澳大利亚，澳大利亚卫生和老龄政府部门;新州癌症协会STREP格兰特（SRP08 - 03）。

11年6月17日

参考
S瓦尔特，H登，J阿明，等。死亡率趋势后，乙型或丙型肝炎病毒感染的诊断：1992-2006。中华肝脏病杂志54（5）:879 - 886（摘要）。 2011年5月。