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 17 January 2018

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News

Barriers to hepatitis C treatment in the era of direct-acting anti-viral agents

This month's issue of the Alimentary Pharmacology & Therapeutics examines barriers to hepatitis C treatment in the era of direct-acting anti-viral agents.

News image

Direct-acting anti-virals are safe, effective treatment of hepatitis C virus (HCV).

Suboptimal linkage to specialists and access to direct-acting anti-virals are the leading barriers to treatment.

However, data are limited.

Dr Kanwal and colleagues from Texas, USA determined predictors of follow-up, receipt of direct-acting anti-virals, and reasons for the lack thereof.

The research team used clinical data from retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow-up in HCV clinics and direct-acting anti-viral treatment.

The researchers then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment.

28% received direct-acting anti-virals
Alimentary Pharmacology & Therapeutics

The team identified 84 221 veterans who were previously seen in HCV clinics during the pre-direct-acting anti-virals era.

Of these, 56% were followed-up in HCV specialty clinics, 29% of whom received direct-acting anti-virals.

Older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection and psychiatric illness were predictors of follow-up.

The research team found that alcohol/drug abuse and medical co-morbidity were predictors of lack of treatment.

Of the 905 prospectively recruited patients, 56% of patients had a specialist visit and 28% received direct-acting anti-virals.

The team observed that common reasons for lack of follow-up were relocation, and missed/cancelled appointments.

Reasons for lack of treatment included waiting for newer therapy, co-morbidities and alcohol/drug abuse.

Dr Kanwal's team concludes, "Half of patients with established HCV care were followed-up in the direct-acting anti-viral era and only 29% received direct-acting anti-virals."

"Targeted efforts focusing on patient and system-levels may improve the reach of treatment with the new direct-acting anti-virals."

Aliment Pharmacol Ther 2017: 46(10): 992–1000
20 November 2017

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