Modelling Death Rates For Carriers Of Hepatitis B
Published online by Cambridge University Press: 22 March 2002
- J. A. DICKINSON
- Affiliation:Department of Community and Family Medicine, The Chinese University of Hong Kong, 4/F School of Public Health, Prince of Wales Hospital, Health Centre, Shatin, N.T., Hong Kong
- Y. T. WUN
- Affiliation:Department of Community and Family Medicine, The Chinese University of Hong Kong, 4/F School of Public Health, Prince of Wales Hospital, Health Centre, Shatin, N.T., Hong Kong
- S. L. WONG
- Affiliation:Department of Community and Family Medicine, The Chinese University of Hong Kong, 4/F School of Public Health, Prince of Wales Hospital, Health Centre, Shatin, N.T., Hong Kong
What Is The Life Expectancy For People Living With Hiv In The Uk
A study published in 2014 looked at the outcomes of over 20,000 adults who started HIV treatment in the UK, between 2000 and 2010. The analysis didnt include people who inject drugs, who tend to have poorer outcomes than other people, but otherwise included a wide range of adults living with HIV.
The key finding was that people who had a good initial response to HIV treatment had a better life expectancy than people in the general population.
Specifically, a 35-year-old man who had a CD4 cell count over 350 and an undetectable viral load one year after starting HIV treatment could expect to live to the age of 81. A 50-year-old man with the same results after one year of treatment was predicted to live to the age of 83. In the general population at this time, men in these age groups were expected to live to 77 and 78 years.
A 35-year-old woman and a 50-year-old woman with the same results could expect to live to 83 and 85 years. This compares to 82 and 83 years in the general population.
“A person living with HIV has a similar life expectancy to an HIV-negative person providing they are diagnosed in good time, have good access to medical care, and are able to adhere to their HIV treatment.”
A 35-year-old man with any of those results could expect to live to 70-72 years. A 50-year-old man was predicted to live to 75-77 years. Women of the same ages could expect to live around two years longer than the men.
Cases Of Hepatitis C In The United States
The CDC reports that in 2018, a total of 15,713 U.S. death certificates had hepatitis C as an underlying or contributing cause of death. This is likely lower than the actual numbers since so many infections go undocumented.
Studies show that baby boomers are more likely than other groups to have been exposed to HCV. Most of them contracted infections between 1970 and 1990 during a peak of new infections.
And since people with an HCV infection might not show symptoms, they may unknowingly transmit the virus to others.
Today, the most common risk factor for hepatitis C in the United States is injection drug use.
Since an HCV infection can show no symptoms, the number of new cases is likely higher than reported, according to the CDC.
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Can You Die From Hepatitis C
Complications from untreated hepatitis C, including cirrhosis and liver cancer, can be fatal, though HCV itself is rarely fatal.
According to the Centers for Disease Control and Prevention , people who develop cirrhosis from HCV have a
more than half of people with an HCV infection will develop chronic hepatitis C. Chronic hepatitis C is long term and can lead to permanent cirrhosis or liver cancer.
Chronic hepatitis C usually has no symptoms. People with chronic hepatitis C may not even know they have it. But once symptoms appear, it means that damage to the liver has already begun.
Life Expectancy By Stage
There are two stages in cirrhosis: compensated and decompensated.
Compensated cirrhosis: People with compensated cirrhosis do not show symptoms, while life expectancy is around 912 years. A person can remain asymptomatic for years, although 57% of those with the condition will develop symptoms every year.
People with decompensated cirrhosis already experience symptoms and complications. Their life expectancy is greatly reduced than those with compensated cirrhosis, while experts recommend referral for a possible liver transplant in these cases.
Physicians use diagnostic tests and scoring to determine a persons stage of cirrhosis, which will help project their life expectancy. The Child-Turcotte-Pugh system awards points based on whether an individual has:
- an abnormal build-up of fluid in the abdomen, and how it responds to treatment
- dysfunction in the brain
- normal levels of albumin, a protein made by the liver
- high levels of bilirubin, which could mean the liver is not working properly
- normal blood clotting time, or international normalized ratio
With the CTP system, a persons score increases according to the number and severity of their symptoms. Based on these scores, the system assigns people into different classes:
- Class A: 56 points
- Class B: 79 points
- Class C: 1015 points
Healthcare professionals will project the life expectancy of people with cirrhosis using CTP scores in the following chart:
| CTP class |
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How Is Life Expectancy Calculated
Life expectancy is the average number of years that a person can expect to live.
More precisely, it is the average number of years an individual of a given age is expected to live if current mortality rates continue to apply. It is an estimate that is calculated by looking at the current situation of a group of people and projecting that into the future.
However, HIV is a relatively new disease and HIV treatment is a rapidly changing area of medicine. It is therefore hard to know whether our current experience will be an accurate guide to the future.
At the moment, there are large numbers of people living with HIV in their twenties, thirties, forties, fifties and sixties. Current death rates are very low, resulting in encouraging figures for future life expectancy. But we have very little experience of people living with HIV in their seventies or eighties, so we know less about the impact HIV may have later in life.
Also, health care for people with HIV is likely to get better in the future. People living with HIV will benefit from improved anti-HIV medications that have fewer side effects, are easier to take and are more effective in suppressing HIV. Doctors understanding of how best to prevent and treat heart disease, diabetes, cancers and other conditions in people with HIV is improving. This could mean that people actually live longer than our current estimates suggest.
Mortality And Survival Plots
General population mortality data were provided for age groups in 5-year intervals. Liver cancer mortality was adjusted for the proportion with an HCC diagnosis, the percentage of HCC associated with hepatitis B, and the population prevalence of HbsAg. The same process was performed for CLD death. Mortality was also analyzed with respect to HbeAg status and adjusted by relative risk and age-specific HbeAg prevalence. The overall carrier mortality rate was obtained by summing the rates of non-liver, HCC, CLD, and non-HCC liver cancer. The values for noncarriers were calculated using the same methods. Survival plots and life expectancies were obtained by using an abridged life table, whereby a hypothetical cohort was subjected to age-specific mortality rates, with survivors proceeding to the subsequent age interval.29 Relative mortality risks were calculated and standardized to the 2006 Taiwan population distribution.
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Whats The Outlook For Hep C Thats Developed Into Cirrhosis Or Liver Cancer
Hepatitis C can lead to cirrhosis, especially if left untreated. Without treatment, cirrhosis can lead to liver cancer and liver failure.
Treating cirrhosis and liver cancer typically requires a liver transplant. A transplant can cure both cancer and liver function impairment. But a transplant is only available for a small number of people.
Adults Living With Hepatitis B
If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection.
All patients with chronic hepatitis B infections, including children and adults, should be monitored regularly since they are at increased risk for developing cirrhosis, liver failure, or liver cancer.
You should make an appointment with a hepatologist or gastroenterologist familiar with hepatitis B. This specialist will order blood tests and possibly a liver ultrasound to evaluate your hepatitis B status and the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment.
Not everyone who tests positive for hepatitis B will require medication. Depending on your test results, you and your doctor might decide to wait and monitor your condition. If your test results indicate that you would be a good candidate for treatment, then your doctor will discuss the current treatment options with you. Whether you start treatment or not, your doctor will want to see you every six months, or at minimum once every year.
Before you start any treatment, make sure you research each treatment option, and ask your doctor to thoroughly explain each option, so that you are well informed. It also might be a good idea to get a second opinion from another doctor before starting any treatment, because more information is always better!
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Coping With A Diagnosis
According to the VA, although cirrhosis is progressive, some people with the condition can move from decompensated, or symptomatic, back to the asymptomatic stage. This is a challenging process, although one of the critical steps is avoiding alcohol of any kind.
To prevent progressing from the asymptomatic to the symptomatic stage, people can make the following lifestyle changes:
- exercising regularly
- keeping to a moderate weight
- getting treatment for conditions that might have caused cirrhosis, such as hepatitis C or B
- getting regular check-ups and prompt treatment for complications
- quitting smoking
Of people who develop cirrhosis, 2060% also develop malnutrition, additional complications, longer hospital stays, and a reduced life expectancy.
This means eating a healthful diet is crucial for those with this condition. Cirrhosis itself can affect diet and metabolism, so people should try:
- consuming a low-salt diet
- avoiding too much vitamin A and D
- avoiding taking vitamin C, if iron levels are high
Who Response
In May 2016, the World Health Assembly adopted the first Global health sector strategy on viral hepatitis, 20162020. The strategy highlighted the critical role of universal health coverage and sets targets that align with those of the Sustainable Development Goals. The strategy proposed the elimination of viral hepatitis as a public health threat by 2030 , and included a roadmap towards elimination by implementing key prevention, diagnosis, treatment and community interventions strategies. In May 2022 the 75th World Health Assembly noted a new set of integrated global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period of 20222030. Based on these previous and now new strategies, a broad range of Member States have developed comprehensive national hepatitis programmes and elimination strategies guided by the global health sector strategy.
To support countries in achieving the global hepatitis elimination targets under the Sustainable Development Agenda 2030, WHO is working to:
- raise awareness, promote partnerships and mobilize resources
- formulate evidence-based policy and data for action
- increase health equities within the hepatitis response
- prevent transmission
- scale up screening, care and treatment services.
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