[Impact of chronic hepatitis C virus (HCV) on survival of schizophrenic patients with co-occurring substance use disorders followed for ten years]

BACKGROUND: Despite disproportionately high rates of HCV infection among patients with schizophrenia and co-occurring substance use disorders, to date, scientific evidence for their survival is lacking.

AIM: The objective of this study was to compare long term survival among this population with and without persisting HCV.

METHODS: Charts of 212 subjects admitted during a period from January 1, 2002 to December 31, 2005 were assessed. Psychiatric diagnoses have been established according to international classification of diseases and health related problems--10th edition (ICD-10). The Kaplan-Meier survival analysis was used to estimate the cumulative survival rates. The association between HCV and mortality was estimated using the Cox proportional hazard regression models, with adjustments for potential confounders. The main outcome was all-cause mortality. Median observation time was 10.0 years.

RESULTS: Period prevalence of HCV was 16.0%. Total all-cause, unadjusted mortality was 50.0% in populations with HCV versus 12.9% in populations without HCV (p < .00001, log rank test]. In Cox regression, mortality was higher for the population with HCV (adjusted hazard ratio = 2.07; 95% confidence interval = 1.4-3.0, p < .0001.

CONCLUSION: The high mortality of schizophrenic dual disorders patients with HCV necessitates new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. The strong adverse effect of HCV on survival should encourage clinical trials including schizophrenic patients with dual disorders, to ascertain whether patients benefit from treatment choices. It is essential that adequate resources and strategies are targeted to the schizophrenic patients with dual disorders with HCV.