- Nonadherence to medical appointments and ongoing substance use are the most common barriers to initiation of HCV direct-acting antiviral (DAA) therapy in eligible Danish patients.
Why this matters
- Guidelines recommend that ongoing substance abuse be addressed prior to initiation of HCV therapy.
- Retrospective analysis of data for 700 HCV-infected patients in the Danish Database for Hepatitis B and C (DANHEP) who fulfilled national fibrosis criteria for DAA care during 2014-2015.
- Funding: Hvidovre Hospital Research Foundation; Capital Region of Denmark’s Research Foundation; Innovation Fund Denmark; Novo Nordisk Foundation; and the Danish Research Council.
- 344 patients (49%) initiated DAA therapy, achieving a sustained virologic response rate of 87.5% (cirrhosis, 87%; severe fibrosis, 89%); the virologic failure rate was 5.5%.
- DAA treatment was predicted by prior HCV therapy (aOR=2.34; 95% CI, 1.53-3.58) and non-injection drug use (IDU) transmission (aOR=2.58; 95% CI, 1.54-4.34).
- 356 patients (51%) failed to initiate treatment, primarily due to missed medical appointments (30%) and ongoing substance use (17%); 6% were treatment-averse due to prior negative experiences or fear of DAA-related events.
- Among patients with ongoing substance use, 75% used alcohol, 13% used drugs, and 12% did both.
- Potentially nongeneralizable.