HCV: IDU, missed appointments as barriers to DAA care in Denmark

  • Sølund C & al.
  • Scand J Gastroenterol
  • 2 May 2018

  • curated by Yael Waknine
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Potentially nongeneralizable.

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