USA :
Les décès pour hépatite C sont maintenant plus fréquents
que ceux provoqués par le VIH
Holmberg S. The growing burden of mortality associated with viral hepatitis in the United States, 1999-2007. The 62nd annual meeting of the American association for the study of liver diseases. 4-8 novembre 2011 - San FranciscoFévrier 2012

Des chercheurs du centre de contrôle et de prévention des maladies (CDCP) ont constaté que les décès liés aux hépatites virales avaient dépassé ceux dus à l'infection par le VIH. Les décès liés à l'hépatite B sont restés constants, ceux dus à l'infection par le VIH ont diminué alors que ceux liés à l'hépatite C (VHC) ont significativement augmenté. Près de 3/4 des décès liés au VHC sont survenus chez les sujets âgés de 45 à 64 ans. Il a été observé que l'infection par le VIH a été l'une des principales comorbidités associées au VHC, à une hépatite chronique, à d'autres hépatites virales et à des maladies hépatiques alcooliques.

Methods: National multiple-cause mortlaity data for 1999-2007, about 21.8 million ecords, were examined for any mention of hepatitis B virus (HBV), hepatitis C virus (HCV), and, for comparison, HIV infection. We assessed age-adjusted mortality rates, proportions of select sociodemographic characteristics, and potentially preventable co-morbidities in hepatitis B- and C-infected decedents in 2007.

Results: From 1999-2007, the HBV-related death rate was almost constant, while deaths associated with HCV increased significantly (annual age-adjusted mortality rate change +0.18 deaths/100,000 per yr) to a total of 15,106 deaths in 2007; by comparison, HIV deaths declined to 12,734 deaths in 2007. Of the HCV-related deaths, 73.4% occurred among persons aged 45-64 years. Co-morbidities associated with increased odds of HCV-related mortality included: chronic liver disease (adjusted odds ratio [ORadj] 32.1); hepatitis B co-infection (ORadj 29.9), alcohol-related conditions (ORadj 4.6); and HIV co-infection (ORadj 1.8). Like HCV, most deaths in HBV-infected persons occurred in those aged 45-64 years (59.4%). Characteristics/factors increasing the odds of HBV-related death included: Asian/Pacific Islander identity (various models, ORadj 13.1-17.2); chronic liver disease (ORadj 34.4); HCV co-infection (ORadj 31.5); HIV coinfection (ORadj 4.0); and alcohol-related conditions (ORadj 3.7).

Conclusion: Mortality associated with viral hepatitis was disproportionately high for middle-aged persons of all races, Asians/Pacific Islanders with hepatitis B, and all minorities with HCV. By 2007 hepatitis C-associated deaths had overtaken HIV as a cause of mortality in the United States. To achieve declines in mortality similar to those seen with HIV require new policy directions and commitment to detect and link infected persons to care and successful treatment.

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