School of Medicine and Health Sciences Poster Presentations

Title

The Impact of HCV Treatment Advances on the HCV Continuum of Care

Document Type

Poster

Keywords

HCV, HIV, DAA, Pegylated-Interferon, Continuum of Care

Publication Date

Spring 2017

Abstract

Background: For treatment of chronic Hepatitis C Virus (HCV) infection, pegylated interferon-based regimens were given prior to 2014 and direct acting agents (DAA) were used as preferred therapy since 2014. We compared the Continuum of Care (CoC) for HCV mono-infected and HCV/HIV co-infected patients for those engaged in care and the effect of the DAA on rates of HCV treatment and HCV suppression.

Methods: A retrospective review of the HCV Clinical Case Registry (HCV CCR) at the Washington, D.C. Veterans Affairs Medical Center (DC-VAMC) was conducted for the pegylated interferon treatment era (2008-2013) and the DAA era (2014-2015). The patients were analyzed based on a modified CoC: HCV diagnosis, engagement in medical care, prescription for HCV medication, and achievement of HCV suppression. HCV diagnosis was based on the HCV CCR confirmation. Engagement in medical care was defined as at least one outpatient encounter at DC-VAMC. Prescription of HCV medication included pegylated interferon during 2008-2013 and simeprevir, sofosbuvir, ledipasvir-sofosbuvir and ombitasvir-paritaprevir-ritonavir with dasabuvir with or without ribavirin during 2014-2015. Finally, HCV suppression was defined as >1 HCV RNA<12 IU/mL after HCV treatment. Chi-square with Yate’s correction and Fisher’s exact test, depending upon sample size, were used to assess for differences between mono-infected and co-infected patients as well as between treatment eras.

Results: During the DAA era (2014-2015), more HCV/HIV co-infected and HCV mono-infected patients were treated (36% vs 5%, p<0.0001; 23% vs. 6%, p<0.0001) and had HCV suppression (86% vs 19%, p<0.0001; 21% vs. 3%, p<0.0001), when compared to the interferon era (2008-2013). More mono-infected patients achieved HCV suppression than co-infected patients (48.32% vs. 18.18%, p= 0.007) in the interferon era (2008-2013). More co-infected patients were treated than mono-infected (36% vs. 23%, p< 0.0001) during the DAA era.

Conclusion: While more co-infected and mono-infected patients achieved HCV viral suppression with DAAs, HCV/HIV co-infected patients treated in the DAA era achieved similar suppression rates compared to mono-infected patients.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Poster to be presented at GW Annual Research Days 2017.

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The Impact of HCV Treatment Advances on the HCV Continuum of Care

Background: For treatment of chronic Hepatitis C Virus (HCV) infection, pegylated interferon-based regimens were given prior to 2014 and direct acting agents (DAA) were used as preferred therapy since 2014. We compared the Continuum of Care (CoC) for HCV mono-infected and HCV/HIV co-infected patients for those engaged in care and the effect of the DAA on rates of HCV treatment and HCV suppression.

Methods: A retrospective review of the HCV Clinical Case Registry (HCV CCR) at the Washington, D.C. Veterans Affairs Medical Center (DC-VAMC) was conducted for the pegylated interferon treatment era (2008-2013) and the DAA era (2014-2015). The patients were analyzed based on a modified CoC: HCV diagnosis, engagement in medical care, prescription for HCV medication, and achievement of HCV suppression. HCV diagnosis was based on the HCV CCR confirmation. Engagement in medical care was defined as at least one outpatient encounter at DC-VAMC. Prescription of HCV medication included pegylated interferon during 2008-2013 and simeprevir, sofosbuvir, ledipasvir-sofosbuvir and ombitasvir-paritaprevir-ritonavir with dasabuvir with or without ribavirin during 2014-2015. Finally, HCV suppression was defined as >1 HCV RNA<12 IU>/mL after HCV treatment. Chi-square with Yate’s correction and Fisher’s exact test, depending upon sample size, were used to assess for differences between mono-infected and co-infected patients as well as between treatment eras.

Results: During the DAA era (2014-2015), more HCV/HIV co-infected and HCV mono-infected patients were treated (36% vs 5%, p<0.0001; 23% vs. 6%, p<0.0001) and had HCV suppression (86% vs 19%, p<0.0001; 21% vs. 3%, p<0.0001), when compared to the interferon era (2008-2013). More mono-infected patients achieved HCV suppression than co-infected patients (48.32% vs. 18.18%, p= 0.007) in the interferon era (2008-2013). More co-infected patients were treated than mono-infected (36% vs. 23%, p< 0.0001) during the DAA era.

Conclusion: While more co-infected and mono-infected patients achieved HCV viral suppression with DAAs, HCV/HIV co-infected patients treated in the DAA era achieved similar suppression rates compared to mono-infected patients.