Loss to Follow-up in the Hepatitis C Care Cascade: A Substantial Problem but Opportunity for Micro-elimination

A Substantial Problem But Opportunity for Micro-elimination

Marleen van Dijk; Joost P.H. Drenth


J Viral Hepat. 2020;27(12):1270-1283. 

In This Article

LTFU During or After Treatment (CHCoC Step 6)

As we know from registration trials, DAAs are highly effective. Real-world studies yield similar results. However, LTFU influences result in real-world studies significantly more. Recently, Darvishian et al showed that LTFU exceeded viral failure in their real-world study, impeding the cascade of care. Studies show that 0%-11% (median 3.4%) of patients become LTFU during therapySuppl file 6,13,26,28,33,37,42,43,50–53,55–57,62 and that 0%-25% (median 4.9%) become LTFU after therapy completion, with missing SVR values.Suppl file 6,13,26,28,33,37,42,43,51–53,55,56,60,62 PWID show similar results with 0.7%-5.6% (median 2.5%) becoming LTFU during treatmentSuppl file 7,40,44,54,58 and 2.5%-28% (median 7.1%) after.Suppl file 7,31,40,41,44,54,58

Many studies report intention-to-treat SVR percentages, defined as the proportion of patients who reached SVR out of the number of patients that initiated DAA therapy (see Figure 2). In studies including mixed populations, ITT SVR varies from 22% to 98% (median 83%).Suppl file 1,2,4–6,12,13,16,18,21–23,25–28,33,35–37,39, 42,43,50–53,55–57,60–62 In studies focusing on PWID populations, ITT SVR ranges from 80% to 92% (median 85%).Suppl file 7,29–32,40,41,44,54,58 Lastly, in studies focusing on HIV/HCV-coinfected populations, ITT SVR ranges from 80% to 96% (median 91%).Suppl file 8–11,15,47–49

Figure 2.

Intention-to-treat sustained virological response percentages in studies included in this review in mixed populations, people who inject(ed) drugs and HIV/HCV-coinfected patients. Each line represents one study or one study group. The corresponding number refers to the reference in Supporting File 1