Effectiveness of direct‐acting antivirals for chronic hepatitis C treatment in migrant and non‐migrant populations in France

Abstract

Despite universal health coverage in France, migrants face specific socioeconomic barriers that increase the likelihood of a suboptimal cascade of care for chronic hepatitis C virus (HCV) infection and impaired treatment effectiveness in this sub‐population. We selected data collected from 2012 to 2018 from the ANRS CO22 HEPATHER prospective cohort study for chronic HCV participants with available data on treatment failure (defined as the presence of a detectable HCV‐RNA load 12 weeks after their first DAA treatment ended). We performed multivariable Poisson regression models to test whether treatment failure rates differed significantly between HCV‐infected migrants and non‐migrants receiving DAA in France (cross‐sectional analysis), while taking into account the former's world region of birth and other potential social vulnerability factors. Among the study population's 7,879 patients, 5,829 (74%) were non‐migrants and 2,050 (26%) migrants. Median [interquartile range] age was 57 [51‐65] years, 4433 (56%) were men and 369 (5%) of the entire study population had treatment failure. After multivariable adjustment, only migrants from Central Asia were at higher risk of treatment failure than non‐migrants (aIRR = 2.83; 95% CI [1.72, 4.65]). Results from this large‐scale study performed in France suggest a higher risk of DAA treatment failure in migrants from Central Asia than in non‐migrants and confirm the overall low treatment failure rate in chronic HCV patients treated with DAA (whether migrants or not). Simplified models of care taking into account language and cultural barriers are needed to improve DAA effectiveness in migrants from Central Asia.

Characteristics and care of chronic hepatitis C treated with direct-acting antivirals in migrants

“…Yet, despite these differences, the SVR 12 rate did not differ between the two, remaining at 97%, in line with rates reported in therapeutic trials [26]. Identical results were observed in two other French studies [7,8]. However, among the migrants of the ANRS Hepather cohort, those from Central Asia were at higher risk of treatment failure than nonmigrants [8].…”

“…In the ANRS Hepather cohort study, the proportion of advanced fibrosis was similar between migrant and nonmigrant populations and close to 40% [7]. Cases of cirrhosis complicated with hepatocellular carcinoma or justifying liver transplant were highly rare in our study, as in the ANRS Hepather study [8]. In our study, the distribution across BMI categories differed between the migrant and nonmigrant populations on both uni- and multivariate analyses, yet the median BMI was identical.…”

“…In the study from Comede (Comité pour la santé des exilés – the French Committee for the Health of Exiles), active within the migrant population living in the Ile de France area, only recently arrived in France and particularly vulnerable, the patients originated from 85 different countries [6]. In the recent French ANRS Hepather prospective cohort study, 5.1% of the migrants were born in the central Asia region (Armenia, Azerbaijan, Georgia, Kazakhstan, Kirghiziztan, Mongolia and Uzbekistan) [8]. In the Italian study conducted in Caserta and Naples and involving 900 foreign undocumented individuals, 50% of the patients were of sub-Saharan African origin and 22% of eastern European origin [5].…”

“…Migrants were defined as individuals not born in France who reported having at least one parent of non-French origin as in the Agence nationale de recherches sur le sida/maladies infectieuses émergentes, National agency for research on AIDS/emerging infectious diseases (ANRS) Hepather study group [8]. All migrant and nonmigrant patients had health insurance at the time of the MDT guaranteeing them access to treatment.…”

Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors

“…Living in poverty was defined as reporting an average monthly household income <1,015 euros per adult equivalent, which corresponds to the poverty line for France in 2015, as defined by the French National Institute for Statistical and Economic Studies (INSEE). 18 Migrant status was defined as being not born in France and having at least 1 parent of non-French origin 19 . A BMI of <18.5, ≥18.5 and <25, ≥25 and <30, ≥30, was classified as underweight, normal weight, overweight, and obesity, respectively.…”