Format

Send to

Choose Destination
BMC Med. 2017 Nov 20;15(1):204. doi: 10.1186/s12916-017-0969-3.

Effectiveness of direct-acting antiviral therapy for hepatitis C in difficult-to-treat patients in a safety-net health system: a retrospective cohort study.

Author information

1
Parkland Health and Hospital System, Dallas, Texas, USA.
2
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
3
University of Texas Health Science Center, San Antonio, Texas, USA.
4
Parkland Health and Hospital System, Dallas, Texas, USA. mamta.jain@utsouthwestern.edu.
5
University of Texas Southwestern Medical Center, Dallas, Texas, USA. mamta.jain@utsouthwestern.edu.

Abstract

BACKGROUND:

Direct-acting antivirals (DAAs) have revolutionized chronic hepatitis C (HCV) treatment, but real-world effectiveness among vulnerable populations, including uninsured patients, is lacking. This study was conducted to characterize the effectiveness of DAAs in a socioeconomically disadvantaged and underinsured patient cohort.

METHODS:

This retrospective observational study included all patients undergoing HCV treatment with DAA-based therapy between April 2014 and June 2016 at a large urban safety-net health system (Parkland Health and Hospital System, Dallas, TX, USA). The primary outcome was sustained virologic response (SVR), with secondary outcomes including treatment discontinuation, treatment relapse, and loss to follow-up.

RESULTS:

DAA-based therapy was initiated in 512 patients. The cohort was socioeconomically disadvantaged (56% uninsured and 13% Medicaid), with high historic rates of alcohol (41%) and substance (50%) use, and mental health disorders (38%). SVR was achieved in 90% of patients (n = 459); 26 patients (5%) were lost to follow-up. SVR was significantly lower in patients with decompensated cirrhosis (82% SVR; OR 0.37, 95% CI 0.16-0.85) but did not differ by insurance status (P = 0.98) or alcohol/substance use (P = 0.34). Reasons for treatment failure included loss to follow-up (n = 26, 5%), viral relapse (n = 16, 3%), non-treatment-related death (n = 7, 1%), and treatment discontinuation (n = 4, 1%). Of patients with viral relapse, 6 reported non-compliance and have not been retreated, 5 have been retreated and achieved SVR, 4 have undergone resistance testing but not yet initiated retreatment, and 1 was lost to follow-up.

CONCLUSIONS:

Effective outcomes with DAA-based therapy can be achieved in difficult-to-treat underinsured populations followed in resource-constrained safety-net health systems.

KEYWORDS:

Chronic hepatitis C; Direct-acting antiviral therapy; Indigent population; Real-world cohort; Safety-net hospital

PMID:
29151365
PMCID:
PMC5694912
DOI:
10.1186/s12916-017-0969-3
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center