All-oral direct antiviral treatment for hepatitis C chronic infection in a real-life cohort: The role of cirrhosis and comorbidities in treatment response

Miotto, Noelle; Mendes, Luciano; Zanaga, Letícia Pisoni; Lazarini, Mariana; Gonçales, Eduardo S L; Pedro, Matheus Kahakura Franco; Gonçales, Fernando Lopes; Stucchi, Raquel Silveira Bello; Vigani, Aline Gonzalez

doi:10.1371/journal.pone.0199941

Cited by 22 publications

(28 citation statements)

References 34 publications

(42 reference statements)

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“…A major advantage of DAA therapy is that there are few contraindications, even in those with advanced liver disease or other comorbidities [62], which supports our finding that multimorbidity was not associated DAA-based treatment initiation. While, in at least one study, early discontinuation of interferon-free therapy was predicted in part by comorbidity burden [38], in our analysis the proportion of DAA-treated patients achieving a SVR was unrelated to prevalence of multimorbidity. Finally, when we restricted our analyses to people with substance use disorders, those who were middle-aged were less likely to receive DAA, although these individuals were equally likely to achieve cure.…”

Section: Discussioncontrasting

confidence: 48%

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HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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Background: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre-and post-direct acting antiviral (DAA) era. Methods: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age-and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. Results: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29-3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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Section: Discussioncontrasting

confidence: 48%

“…However, whether multimorbidity remains a barrier to treatment initiation and successful antiviral treatment outcome in the DAA era is unclear. In two cohort evaluations of DAA recipients, the presence of comorbidities predicted diminished antiviral treatment outcomes [37,38].…”

Section: Introductionmentioning

confidence: 99%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

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“…A major advantage of DAA therapy is that there are few contraindications, even in those with advanced liver disease or other comorbidities [48], which supports our finding that multimorbidity was not associated DAA-based treatment initiation. While, in at least one study, early discontinuation of interferon-free therapy was predicted in part by comorbidity burden [24], in our analysis the proportion of DAAtreated patients achieving a SVR was unrelated to prevalence of multimorbidity. Finally, when we restricted our analyses to people with substance use disorders, those who were middle-aged were less likely to receive DAA, although these individuals were equally likely to achieve cure.…”

Section: Discussioncontrasting

confidence: 48%

“…In two cohort evaluations of DAA recipients, the presence of comorbidities predicted improved outcomes. [23,24] In this study, we uniquely used diverse HCV clinical cohort data linked to robust health administrative databases from a universal, single-payer healthcare system. We used these data to comprehensively describe the prevalence of physical and mental health comorbidities and their multimorbidity in a cohort of people living with HCV and to compare this prevalence to an age-, sex-, and geographicallymatched population without HCV.…”

Section: Introductionmentioning

confidence: 99%

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

Cooper

Galanakis

Donelle

et al. 2019

Preprint

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Background Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment in the pre- and post-direct acting antiviral (DAA) era. Methods We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and DAA HCV treatments. Results The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29 – 3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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“…In two cohort evaluations of DAA recipients, the presence of comorbidities predicted diminished antiviral treatment outcomes. [37,38] In this study, we uniquely used diverse HCV clinical cohort data linked to robust health administrative databases from a universal, single-payer healthcare system. We used these data to comprehensively i) describe the prevalence of physical and mental health comorbidities and their multimorbidity in a cohort of people living with HCV; ii) compare this prevalence to an age-, sex-, and geographicallymatched population without HCV; iii) examine the association between multimorbidity and HCV treatment with interferon-and DAA-based antiviral therapy initiation, and; iv) among those treated with DAA, examine the association between multimorbidity and cure.…”

mentioning

confidence: 99%

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

Cooper

Galanakis

Donelle

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre- and post-direct acting antiviral (DAA) era. Methods: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. Results: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29 – 3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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All-oral direct antiviral treatment for hepatitis C chronic infection in a real-life cohort: The role of cirrhosis and comorbidities in treatment response

Cited by 22 publications

References 34 publications

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

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