Abstract
Background
Vulnerable populations are disproportionately affected by hepatitis C virus (HCV) infection and experience high rates of health disparity. There are no data on real-world experience with highly efficacious direct-acting anti-HCV treatment in this population.
Aims
We aimed to evaluate the real-world experience with sofosbuvir-based regimens among a vulnerable HCV-infected population.
Methods
HCV treatment response was assessed among 204 patients who completed 12–24 weeks of sofosbuvir-based regimens (in combination with pegylated interferon and ribavirin, simeprevir, ledipasvir, or daclatasvir) at the San Francisco safety-net healthcare system liver specialty clinic between January 2014 and December 2015. Virologic response during therapy was assessed at weeks 4 and 8, end of therapy, and 12-week treatment discontinuation (SVR 12).
Results
Patient characteristics were median age 58 years, 60 % male, 42 % Caucasian (21 % black, 19 % Hispanic), 72 % had genotype 1 (23 % genotype 2 or 3), and the median baseline log10 HCV viral load was 6.1 IU/ml and alanine transaminase 63 U/l. Cirrhosis was present in 36 % (of whom 40 % were decompensated), and 18 % were HCV treatment-experienced. Overall, SVR 12 was achieved in 97 % (99 % genotype 1, 100 % genotype 2, 84 % genotype 3). Five of six (83 %) patients who relapsed had decompensated cirrhosis, and 67 % were also non-adherent to therapy. On-treatment virologic response did not impact SVR.
Conclusions
High rates of sustained virologic response can be achieved in safety-net HCV-infected patients. Access to DAA-based regimens is critical to addressing HCV-related health disparity in this at-risk population.
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Funding
This work was supported in part by National Institutes of Health K24AA022523 (to M.K.) and P30 DK026743 (UCSF Liver Center).
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There are no conflicts of interest in connection with the submitted manuscript. Dr. Khalili has research grant support from Gilead Inc and Intercept Pharmaceuticals and has participated in the advisory boards of Bristol Myers Squibb, Gilead Inc, and Intercept Pharmaceuticals.
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Beck, K.R., Kim, N. & Khalili, M. Sofosbuvir-Containing Regimens for Chronic Hepatitis C Are Successful in the Safety-Net Population: A Real-World Experience. Dig Dis Sci 61, 3602–3608 (2016). https://doi.org/10.1007/s10620-016-4340-x
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DOI: https://doi.org/10.1007/s10620-016-4340-x