Telemedicine HCV Treatment in Department of Corrections Results in High SVR in Era of Direct-acting Antivirals

Taseen A. Syed; Reena Cherian; Shawn Lewis; Richard K. Sterling

Disclosures

J Viral Hepat. 2020;28(1):209-212. 

In This Article

Results

Patient Characteristics

Of the 38 DOC facilities in Virginia, the 25 with 24-hour nursing and telemedicine facilities participated in our HCV treatment protocol. Between June 2015 and December 2019, 870 incarcerated individuals with chronic HCV initiated treatment from DOC facilities throughout Virginia. The mean (±SD) age of our DOC treatment population was 50 (±11) years, 90% were male, 63% were Caucasian, 36% were African American, 4% were coinfected with HIV (all on anti-HIV therapy with CD4 > 200 cells/mm3 and HIV RNA < 400 copies/mL), six (0.5%) had HBV (all on anti-HBV therapy for at least 4 weeks prior to starting DAA), and 92% were HCV treatment naive. The majority had either cirrhosis (62%) or bridging fibrosis (18%) with median FIB-4 score 2.15 (1.31–3.56) reflective of the DOC referral pattern of prioritizing those with advanced fibrosis.

Treatment Selection

Of the 870 patients, 76% were treated with a 12-week DAA course and 22% received 8 weeks. The most common DAA used was sofosbuvir/velpatasvir for 12 weeks (39%, n = 340), while glecaprevir/pibrentasvir for 8 weeks (21%) or 12 weeks (11%) was used in 275 subjects, ledipasvir/sofosbuvir for 12 weeks in 26% (n = 226), and elbasvir/grazoprevir for 12 weeks in 3% (n = 29) of patients. Ribavirin was mostly used (21%, n = 173) with ledipasvir/sofosbuvir for treatment of GT 1 (n = 165) or with sofosbuvir/velpatasvir in GT 3 (n = 8) cirrhotic patients in our early experience.

Treatment Response

Treatment compliance was near 100%. The overall SVR-12 was 97% and was similar among all DAA regimens (Figure 1). Specifically, the SVR-12 rate was observed in 98% with sofosbuvir/velpatasvir, 98% with glecaparevir/pibrenasvir, 97% with ledipasvir/sofosbuvir and 100% with elbasvir/grazoprevir. There was a high rate of SVR among the regimens irrespective of age, sex, race, HIV status, fibrosis level, GT, ribavirin use, adherence, prior treatment experience or DAA duration on SVR-12. We did not observe any case of HBV reactivation.

Figure 1.

Comparison of sustained virologic response (SVR)-12 rate (%) among different direct-acting antiviral (DAA) regimens

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