What is the impact of a country-wide scale-up in antiviral therapy on the characteristics and sustained viral response rates of patients treated for hepatitis C?

Scott A. McDonald, Hamish A. Innes, Peter C. Hayes, John F. Dillon, Peter R. Mills, David J. Goldberg, Stephen Barclay, Sam Allen, Ray Fox, Andrew Fraser, Nicholas Kennedy, Diptendu Bhattacharyya, Sharon J. Hutchinson

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: The global burden associated with hepatitis C virus (HCV) infection has prompted a scale-up of antiviral therapy. Hitherto, no data exist on the impact of scaling-up, on the characteristics of treated populations, or on sustained viral response (SVR) rates. We assessed the country-wide scale-up of antiviral therapy in Scotland, a country which nationally monitors uptake of and response to HCV treatment.

Methods: Data for patients, initiated on combined pegylated interferon and ribavirin therapy at 13 specialist HCV clinics in 2001-2010, were extracted from the Scottish HCV Clinical Database (n = 3895). Patient characteristics included age, genotype, PWID (people who inject drugs) status, prison referral, and diagnosed cirrhosis. Temporal trends in covariates and adjusted effects on a SVR were examined via mixed-effects regression.

Results: The number of patients starting treatment increased from 237 in 2001-2002 to 1560 in 2009-2010, with an increasing trend in SVR from 44% to 57% over this period. For a given clinic, between 2001/2 and 2010 there was a decrease in the odds of those treated being diagnosed with cirrhosis (odds ratio [OR] = 0.84 per year), and increasing temporal trends for those treated being PWID (OR = 1.08) and prison referrals (OR = 1.06). Adjusting for covariates, the proportion of a given clinic's patients achieving SVR was positively associated with the percentage of PWID (OR = 1.01 per percent increase; 95% confidence interval [CI]: 1.00-1.02) and genotype 2/3 (OR = 1.03; 95% CI: 1.02-1.04).

Conclusions: Despite changes in patient characteristics, a country-wide scale-up of antiviral therapy did not compromise SVR rates. Results are highly relevant to countries planning on scaling-up treatment, given the forthcoming availability of new interferon-free therapies.

Original languageEnglish
Pages (from-to)262-268
Number of pages7
JournalJournal of Hepatology
Volume62
Issue number2
Early online date6 Sep 2014
DOIs
Publication statusPublished - Feb 2015

Keywords

  • Antiviral therapy
  • Hepatitis C virus
  • Pegylated interferon
  • Sustained viral response

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