Dramatic Increase in HCV Cure Rate Among Veterans

Jennifer Garcia

March 15, 2017

Use of direct-acting antiviral drugs (DAAs) has led to a 21-fold increase in the cure rate for hepatitis C virus (HCV) infections among patients treated in the Veterans Affairs (VA) healthcare system between 1999 and 2015, according to a new study.

"Further increases in funding and cost reductions of DAAs in 2016 suggest that the VA could cure the majority of HCV-infected Veterans in VA care within the next few years," write George N. Ioannou, MD, associate professor and director of hepatology at the Veterans Affairs Puget Sound Healthcare System and University of Washington in Seattle, and colleagues. Their results were published online March 8 in Alimentary Pharmacology & Therapeutics.

The researchers evaluated data from 78,947 patients being treated for HCV within the VA system, the largest provider of care for chronic HCV infection in the United States. Data from patients who initiated therapy between January 1, 1999, and December 31, 2015, were included. Pretreatment HCV viral load was compared with HCV viral load at least 4 weeks after the end of HCV treatment to determine whether a sustained virological response (SVR) was attained, defined as a viral load below the lower limit of quantification after treatment. The average age of the patients was 56.2 ± 7.7 years; 61.7% were white, 29.3% were black, and the majority were men.

Cure rates increased steadily, going from 19.2% in 1999 to 36.0% in 2010 before a remarkable increase to 90.5% in 2015. "The number of patients achieving SVR was 1313 in 2010, the last year of the interferon era, and increased 5.6-fold to 7377 in 2014 and 21-fold to 28 084 in 2015," write the authors.

Dr Ioannou and colleagues specifically point out that "[t]he number of patients cured in 2015 (n = 28 084) represented almost half of all patients cured in the entire 17-year period (n = 57 445)."

Moreover, treatment among specific, previously difficult-to-treat groups, was pronounced. These included patients with cirrhosis (13.4-fold increase), hepatocellular carcinoma (20.6-fold increase), genotype 1 HCV (11.3-fold increase), and advanced age (28.5-fold increase) compared with an 8.5-fold increase among all patients.

The authors note that treatment rates were directly correlated with the availability of federal funds for DAAs, and that the high cost of some DAAs led to a decline in treatment rates as funds were depleted. Overall, however, greater provision of DAAs, as well as greater efficacy of these medications in recent years, has led to steady increases in SVR rates in this patient population.

Whereas the availability of DAA funding is likely the most important determinant of treatment rates, other factors such as the use of teleconsultation, aggressive screening practices, and implementation of coordinated care for HCV-infected veterans have also "contributed to the remarkable increases in HCV treatment and cure rates that occurred in 2014 and 2015."

Further, the authors go on to note that removal of treatment prioritization guidelines within the VA and other select healthcare systems, will likely lead to even greater treatment rates in 2016 and beyond, but acknowledge that other factors such as training, staffing, and infrastructure may also affect treatment implementation.

"Considering that HCV infection is the most common cause of cirrhosis and liver cancer in the VA and the United States, that the benefits of SVR are long-lasting and that HCV clearance reduces the risk of liver cancer by 76% and all-cause mortality by 50%, the potential public health benefits of large-scale HCV treatment are great," write Dr Ioannou and colleagues.

Funding for this study was provided through a grant from the US Department of Veterans Affairs. The authors have disclosed no relevant financial relationships.

Aliment Pharmacol Ther. Published online March 8, 2017. Full text

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