Health outcomes among surveyed patients infected with hepatitis C in the Chronic Hepatitis Cohort Study (CHeCS)

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Background: Understanding disease progression among patients with chronic hepatitis C virus (HCV) infection is vital for appropriate clinical decision‐making. The objectives of this study were to describe outcomes observed among a cohort of chronically infected HCV patients who had completed an in‐depth health and behavior survey and determine characteristics associated with progression to severe clinical sequelae (cirrhosis, decompensated cirrhosis [DC], hepatocellular carcinoma [HCC], or liver transplant). Methods:HCV‐infected patients at four large U. S. healthcare systems participating in CHeCS completed a cross‐sectional survey of demographic characteristics, risk behaviors, and physical and psychosocial functioning during 2011‐2012. Patients co‐infected with hepatitis B virus or human immunodeficiency virus were excluded from analyses. We examined survey responses and electronic medical records to determine patient characteristics associated with severe disease outcomes over the course of observation from the patient's first‐ever health system visit through the end of 2014. Results: At the time of survey, among 4754 eligible HCV‐infected respondents, mean age was 56 years, 56% were male, 69% were non‐Hispanic white, 53% had private insurance, 34% were current smokers, 21% reported current alcohol abuse/dependence by AUDIT‐C score, and 52% reported history of injection drug use (IDU). By the end of observation, 712 (15.0%) patients were diagnosed with DC, 189 (4.0%) with HCC, 277 (5.8%) received liver transplants, and 236 (5.0%) died. HCV treatment resulted in sustained virologic response (SVR) in 1100 (23.1%) patients. Clinical endpoints observed with greater frequency as self‐reported duration of HCV infection increased included: cirrhosis (p<0.001), DC (p<0.001), HCC (p<0.001), liver transplant (p<0.001), and death (p=0.019). Demographic and behavioral factors associated with progression to DC, HCC, or transplant in a multivariable model included: age ≥70 years (p=0.018), male gender (p<0.001), Black race (p=0.007), current alcohol abuse/dependence (p=0.016), history of IDU (p=0.020), and depression (p=0.005). Conclusion: The extensive survey of HCV‐infected CHeCS patients provides a novel source of data on risk behaviors, physical and psychosocial functioning, comorbidities, and their respective impact on the course of an HCV‐infected patient's disease. Modifiable factors associated with progression among survey respondents included depression and current alcohol abuse/ dependence. Of note, 23% of patients achieved SVR, 6% were transplanted, and 5% died prior to the advent of all‐oral direct acting antiviral therapy.





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