Challenges in hepatitis C elimination despite highly effective antiviral agents in patients with and without intravenous drug use

Bota, Simona; Razpotnik, M; Hucke, Florian; Urak, C; Flatscher, Kerstin; Peck‐Radosavljevic, Markus

doi:10.1007/s00508-021-01868-1

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…The asymptomatic nature of infection and potential mistrust makes patients hesitant to undergo DAA in the Somalis [15]. In Australia, Canada, and other countries, the issues of persons who inject drugs (PWIDs) were faced [36,37]. Gender, human immunodeficiency virus (HIV), and ethnicity might cause the different rates of treatment acceptance [38].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Refusal of Direct-Acting Antiviral Agents for the Treatment of Hepatitis C in Taiwan

Chang

Chen

et al. 2022

Medicina

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Background and Objectives: Direct-acting antiviral agents (DAA) are a safe and highly effective treatment for hepatitis C virus (HCV) infection. However, the uptake of DAA treatment remains a challenge. This study aims to examine the reasons for DAA refusal among HCV patients covered by the Taiwan National Health Insurance system. Materials and Methods: This retrospective observational study covered the period from January 2009 to December 2019 and was conducted at a single hepatitis treatment center in Taiwan. This study involved chart reviews and phone-based surveys to confirm treatment status and refusal causes. To confirm treatment status, subjects with HCV without treatment records were phone-contacted to confirm treatment status. Patients who did not receive treatment were invited back for treatment. If the patient refused, the reason for refusal was discussed. Results: A total of 3566 patients were confirmed with DAA treatment; 418 patients (179 patients who were lost to contact or refused the survey and 239 patients who completed the survey of DAA refusal) were included in the no-DAA-therapy group. Factors associated with receiving DAAs were hemoglobin levels, hepatitis B virus co-infection, and regular gastroenterology visits. Meanwhile, male sex, platelet levels, and primary care physician visits were associated with DAA refusal. The leading causes of treatment refusal were multiple comorbidities, low health literacy, restricted access to hospitals, nursing home residence, and old age. The rate of DAA refusal remains high (10%). Conclusions: The reasons for treatment refusal are multifactorial, and addressing them requires complex interventions.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with the Refusal of Direct-Acting Antiviral Agents for the Treatment of Hepatitis C in Taiwan

Chang

Chen

et al. 2022

Medicina

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“…Among PWID infected with HCV, one study showed that SVR was lower than among the general population infected with HCV (61.5% vs 91.5%). [22] However, data from other studies suggest that SVR is similar among PWID infected with HCV and general populations infected with HCV. [17,22,23] A study that compared treatment models for HCV in PWID showed that SVR rates were high regardless of treatment model, and increases in adherence were associated with greater likelihood of SVR.…”

Section: )[18]mentioning

confidence: 96%

“…22 However, data from other studies suggest that SVR is similar among PWID infected with HCV and general populations infected with HCV. 17 22 23 A study that compared treatment models for HCV in PWID showed that SVR rates were high regardless of treatment model, and increases in adherence were associated with greater likelihood of SVR. 24 In a separate study, nonadherence was significantly higher among PWID versus the general population (19.4% vs. 8.9%; p = 0.004).…”

Section: Considerations In Evaluating Hcv Therapy Adherencementioning

confidence: 96%

Adherence in Hepatitis C Virus Treatment: What We Know

Flamm,

Mangia

2024

Semin Liver Dis

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Although therapy with direct-acting antiviral (DAA) agents achieves high HCV cure rates and is forgiving of missed doses, certain patient populations, such as people who inject drugs (PWID), are often denied therapy because of a perceived high risk of nonadherence. However, a relationship between adherence to DAAs for various patient populations and efficacy has not been well defined. The lack of a standardized method for evaluating adherence complicates making comparisons between studies, making it difficult to develop and implement novel measures that may improve adherent behavior. Traditional methods for assessing adherence may overestimate medication adherence, while newer, technology-based methods may assist with accurately assessing and maintaining patient adherence to therapy. Data demonstrate that special populations of patients with HCV, such as PWID, can be successfully treated, with relatively high rates of sustained virologic response (SVR) despite less-than-optimal adherence. While rates of adherence, and subsequently SVR, can be improved, antiviral therapy should not be withheld because of fear of nonadherence. This paper addresses medication adherence and forgiveness of DAA regimens, such as sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, in different patient populations with HCV. Considerations in evaluating adherence in HCV therapy and available methods for assessing adherence are detailed.

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“…In Australia, in 2015, an estimated 180,000 people were living with untreated HCV, with an estimated 80% of all infections diagnosed [14]. Since the inclusion of DAAs in Australia's Pharmaceutical Benefits Scheme (PBS) in 2016, over 100,000 individuals have been prescribed treatment for HCV infection [2,[14][15][16]. Australia was one of the first countries to introduce universal treatment of HCV without restriction, including treatment of reinfection, whilst also having one of the lowest costs for DAA treatment out of all high-income countries [1,16].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C (HCV) Reinfection and Risk Factors among Clients of a Low-Threshold Primary Healthcare Service for People Who Inject Drugs in Sydney, Australia

Read,

Tang,

Silins

et al. 2024

Viruses

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Hepatitis C (HCV) reinfection studies have not focused on primary healthcare services in Australia, where priority populations including people who inject drugs (PWID) typically engage in healthcare. We aimed to describe the incidence of HCV reinfection and associated risk factors in a cohort of people most at risk of reinfection in a real-world community setting. We conducted a secondary analysis of routinely collected HCV testing and treatment data from treatment episodes initiated with direct-acting antiviral (DAA) therapy between October 2015 and June 2021. The overall proportion of clients (N = 413) reinfected was 9% (N = 37), and the overall incidence rate of HCV reinfection was 9.5/100PY (95% CI: 6.3–14.3). Reinfection incidence rates varied by sub-group and were highest for Aboriginal and/or Torres Strait Islander people (20.4/100PY; 95% CI: 12.1–34.4). Among PWID (N= 321), only Aboriginality was significantly associated with reinfection (AOR: 2.73, 95% CI: 1.33–5.60, p = 0.006). High rates of HCV reinfection in populations with multiple vulnerabilities and continued drug use, especially among Aboriginal and Torres Strait Islander people, highlight the need for ongoing regular HCV testing and retreatment in order to achieve HCV elimination. A priority is resourcing testing and treatment for Aboriginal and/or Torres Strait Islander people. Our findings support the need for novel and holistic healthcare strategies for PWID and the upscaling of Indigenous cultural approaches and interventions.

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Challenges in hepatitis C elimination despite highly effective antiviral agents in patients with and without intravenous drug use

Cited by 6 publications

References 15 publications

Factors Associated with the Refusal of Direct-Acting Antiviral Agents for the Treatment of Hepatitis C in Taiwan

Factors Associated with the Refusal of Direct-Acting Antiviral Agents for the Treatment of Hepatitis C in Taiwan

Adherence in Hepatitis C Virus Treatment: What We Know

Hepatitis C (HCV) Reinfection and Risk Factors among Clients of a Low-Threshold Primary Healthcare Service for People Who Inject Drugs in Sydney, Australia

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