Patients with hepatitis C virus (HCV) have a higher prevalence of comorbidities and multimorbidity compared with the general population, according to a study published in BMC Infectious Diseases.
In this retrospective cohort study, researchers used a validated algorithm to determine the prevalence of HCV comorbidities using patient data from the Ottawa hospital viral hepatitis program linked to administrative data from IC/ES (formerly Institute for Clinical Evaluative Sciences) as of April 1, 2017. Adults aged ≥18 years with HCV (n=1209) were compared with age- and sex-matched Ottawa-area residents (n=6045). Comorbidities included acute myocardial infarction, asthma, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), dementia, diabetes, hypertension, HIV, and rheumatoid arthritis.
In patients with HCV, the prevalence was significantly higher for asthma (prevalence ratio [PR] 1.32; 95% CI, 1.06-1.64), any cancer (PR 1.76; 95% CI, 1.22-2.55), COPD (PR 2.42; 95% CI, 1.73-3.39), diabetes (PR 1.32; 95% CI, 1.06-1.64), and renal failure (PR 2.92; 95% CI, 1.90-4.48). There was no difference in cardiac outcomes (arrhythmias, CHF, chronic coronary syndrome) between the 2 groups.
All mental health conditions, including nonpsychotic mood and anxiety disorders (PR 2.22; 95% CI, 1.86-2.64), other mental health illnesses (PR 2.71; 95% CI, 2.06-3.55), and substance use (PR 26.50; 95% CI, 18.35-38.27) were significantly more prevalent in patients with HCV liver failure was significantly more prevalent in patients with HCV (PR 6.63; 95% CI, 2.72-11.81). Multimorbidity (PR 1.38; 95% CI, 1.38-1.58) and combined physical-mental health comorbidity (PR 2.71; 95% CI, 2.29-3.20) were significantly more prevalent in patients with HCV.
This study is limited by the inability to ascertain treatment outcomes in patients who were lost to follow-up, estimates that are restricted only to patients who are diagnosed with HCV and receiving care, and the potential introduction of bias if multimorbidity of those lost to follow-up had significantly different morbidity from those who were retained.
The findings that patients with HCV have a higher prevalence of comorbidity and multimorbidity compared with the general population points to the need for integrated, comprehensive, and community-oriented approaches to HCV care delivery, with particular emphasis on mental health and addiction care. Strategies might include involving peers in care, case management, integration of HCV care with substance use, social service delivery, primary care services, use of telehealth services, and guidance for self-management strategies.
Cooper CL, Galanakis C, Donelle J, et al. HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study [published online August 23, 2019]. BMC Infect Dis. doi: 10.1186/s12879-019-4315-6