Background. Achievement of a sustained virologic response (SVR) after treatment for Hepatitis C infection is associated with improved outcomes. This meta-analysis aimed to determine the impact of SVR on long-term mortality risk compared with non-responders in a range of populations.

Methods. An electronic search identified all studies assessing all-cause mortality in SVR and non-SVR patients. Eligible articles were stratified into general, cirrhotic, and HIV co-infected populations. The adjusted hazard ratio (95%CI) for mortality in patients achieving SVR versus non-SVR, and pooled estimates for the five-year mortality in each group were calculated.

Results. 31 studies (n=33,360) were identified as suitable for inclusion. Median follow-up time was 5.4 years (IQR 4.9-7.5) across all studies. The adjusted hazard ratio of mortality for patients achieving SVR versus non-SVR was 0.50 (95%CI 0.37-0.67) in the general population, 0.26 (95%CI 0.18-0.74) in the cirrhotic group, and 0.21 (0.10-0.45) in the co-infected group. The pooled five-year mortality rates were significantly lower for patients achieving SVR compared with non-SVR in all three populations.

Conclusions. The results suggest that there is a significant survival benefit of achieving an SVR compared with unsuccessful treatment in a range of HCV-infected populations.