Correlates of Initiation of Treatment for Chronic Hepatitis C Infection in United States Veterans, 2004–2009

Gundlapalli, Adi V.; Nelson, Richard E.; Haroldsen, Candace; Carter, Marjorie E.; LaFleur, Joanne

doi:10.1371/journal.pone.0132056

Cited by 9 publications

(9 citation statements)

References 35 publications

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“…The low overall treatment rate of 11.9% is consistent with those published for the USA, Canada and Australia, with these published rates ranging from 1.1% to 25.6% . Those studies identified a number of factors associated with treatment initiation, with older age, current drug and alcohol use, and comorbidities being associated with a reduced likelihood of treatment. In addition, patients reported deferring treatment until the availability of better therapies, because of treatment‐related perceptions, ability to comply and concerns with side effects …”

Section: Discussionsupporting

confidence: 82%

Establishing the cascade of care for hepatitis C in England—benchmarking to monitor impact of direct acting antivirals

Simmons

Ireland

Irving

et al. 2018

Journal of Viral Hepatitis

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Little is known about engagement and retention in care of people diagnosed with chronic hepatitis C (HCV) in England. Establishing a cascade of care informs targeted interventions for improving case finding, referral, treatment uptake and retention in care. Using data from the sentinel surveillance of blood-borne virus (SSBBV) testing between 2005 and 2014, we investigate the continuum of care of those tested for HCV in England. Persons ≥1 year old with an anti-HCV test and subsequent RNA tests between 2005 and 2014 reported to SSBBV were collated. We describe the cascade of care, as the patient pathway from a diagnostic test, referral into care, treatment and patient outcomes. Between 2005 and 2014, 2 390 507 samples were tested for anti-HCV, corresponding to 1 766 515 persons. A total of 53 038 persons (35 190 men and 17 165 women) with anti-HCV positive were newly reported to SSBBV. An RNA test was conducted on 77.0% persons who were anti-HCV positive, 72.3% of whom were viraemic (RNA positive) during this time period, 21.4% had evidence of treatment and 3130 49.5% had evidence of a sustained virological response (SVR). In multivariable models, confirmation of viraemia by RNA test varied by age and region/test setting; evidence of treatment varied by age, year of test and region/test setting; and SVR varied by age, year of test and region/setting of test. In conclusion, our findings provide HCV cascade of care estimates prior to the introduction of direct acting antivirals. These findings provide important baseline cascade estimates to benchmark progress towards elimination of HCV as a major public health threat.

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Section: Discussionsupporting

confidence: 82%

Establishing the cascade of care for hepatitis C in England—benchmarking to monitor impact of direct acting antivirals

Simmons

Ireland

Irving

et al. 2018

Journal of Viral Hepatitis

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“…Interestingly, genotype did not significantly affect treatment decision in the Korean population (58.3% in GT 1 vs 61.7% in GT 2, p=0.302, data now shown), which was not consistent with previous studies 13,20. In this multicenter study, the decision to initiate treatment was based on each physician’s preference, which may have put different emphasis on genotype when deciding to initiate antiviral treatment.…”

Section: Discussioncontrasting

confidence: 71%

“…A recent U.S. study including 101,444 Veterans showed that treatment initiation rate was very low (7.4%), and those with genotype 2/3, non-white race, and Medicare or other insurances were correlated with high treatment initiation rates. 13 In a recent Taiwan study, the treatment rate was 13.7% in the estimated HCV-viremic population of 554,361. 8 The treatment initiation rate reported in this study was much higher than in previous reports.…”

Section: Discussionmentioning

confidence: 99%

Final Report of Unmet Needs of Interferon-Based Therapy for Chronic Hepatitis C in Korea: Basis for Moving into the Direct-Acting Antiviral Era

Jang

Kim

et al. 2017

Gut and Liver

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Background/AimsTo evaluate the era of direct acting antivirals (DAAs), we must understand the treatment patterns and outcomes of interferon-based therapy for hepatitis C virus (HCV) infection. We aimed to elucidate the treatment rate, factors affecting treatment decisions, and efficacy of interferon-based therapy in a real-world setting.MethodsThis nationwide cohort study included 1,191 newly diagnosed patients with chronic HCV infection at seven tertiary hospitals in South Korea. Subjects were followed retrospectively until March 2015, which was just before the approval of DAA therapy.ResultsIn total, 48.2% and 49.3% of the patients had HCV genotypes 1 and 2, respectively. Interferon-based therapy was initiated in 541 patients (45.4%). The major reasons for no treatment included ineligibility (18.9%), concern about adverse events (22.3%), cost (21.5%), and an age >75 years (19.5%). Interferon-based therapy was discontinued (18.5%) mainly due to adverse events (n=66). The intent-to-treat analysis found that the sustained virologic response (SVR) rate was 58.3% in genotype 1 patients and 74.7% in non-genotype 1 patients.ConclusionsApproximately one-third of newly diagnosed HCV patients in South Korea received interferon-based therapy and showed a suboptimal SVR rate. Diagnosis of patients at younger ages and with a less advanced liver status and reducing the DAA therapy cost may fulfill unmet needs.

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“…As shown in Table 1 , a total of 39 studies with 476,443 CHC patients (37 articles and 2 abstracts) met eligibility criteria and were included in our primary meta-analyses. [ 3 , 4 , 6 , 7 , 14 – 48 ] Most studies were from North America (19/39, 49%) or Europe (11/39, 28%). Eight (21%) were from the Asia or Pacific regions.…”

Section: Resultsmentioning

confidence: 99%

“…Several U.S. based studies report treatment rates with pegylated-interferon (PEG-IFN) and ribavirin (RBV) that range from nine to 36%. [ 3 – 7 ] In their report the WHO also estimates that under 1% of treatment eligible CHC patients worldwide have received antiviral therapy. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis

Vutien

Jin

et al. 2017

PLoS ONE

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Background & aimsTreatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C.MethodsWe conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity.ResultsWe included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1–30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04), region (Europe vs. North America p = 0.004), and data source (clinical chart review vs. administrative database, p = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care.ConclusionsOnly one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.

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Correlates of Initiation of Treatment for Chronic Hepatitis C Infection in United States Veterans, 2004–2009

Cited by 9 publications

References 35 publications

Establishing the cascade of care for hepatitis C in England—benchmarking to monitor impact of direct acting antivirals

Establishing the cascade of care for hepatitis C in England—benchmarking to monitor impact of direct acting antivirals

Final Report of Unmet Needs of Interferon-Based Therapy for Chronic Hepatitis C in Korea: Basis for Moving into the Direct-Acting Antiviral Era

Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis

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