The Changing Characteristics of Patients Infected With Chronic Hepatitis C Virus From 2014 to 2019

Real-world Data From the German Hepatitis C-registry (DHC-R)

Dietrich Hüppe; Albrecht Stoehr; Peter Buggisch; Stefan Mauss; Hartwig Klinker; Gerlinde Teuber; Dennis Hidde; Kristina Lohmann; Mark Bondin; Heiner Wedemeyer

Disclosures

J Viral Hepat. 2021;28(10):1474-1483. 

In This Article

Abstract and Introduction

Abstract

The number of patients diagnosed with hepatitis C virus (HCV) is markedly higher than the number initiating treatment indicating gaps in the care cascade, likely centred around reaching at-risk populations. Understanding changing characteristics of patients with HCV allows for targeted programs that increase linkage to care. We investigated changes in demographic and clinical characteristics of patients registered in the German Hepatitis C-Registry (DHC-R) from 1 January 2014 to 31 December 2019. The DHC-R is an ongoing, noninterventional, multicentre, prospective, observational cohort registry including 327 German centres. Patient characteristics were analysed over time in 7 phases for all patients completing a screening visit. Overall, 14,357 patients were enrolled. The percentage of treatment-naïve/non-cirrhotic patients increased from 34.4% in phase 1 (1 January–31 December 2014) to 68.2% in phase 7 (1 August–31 December 2019). The proportion of migrants, alcohol users, people who inject drugs, and those receiving opiate substitution therapy increased in later registry phases. Most patients (60.1%) were receiving comedication at baseline. The most prescribed comedications were drugs used to treat opioid dependence which increased from 9.2% in phase 1 to 24.0% in phase 7. The patients' mean age decreased from 52.3 years in phase 1 to 48.7 years in phase 7. From 2014 to 2019, the proportion of at-risk patients enrolling in the registry increased. To eliminate viral hepatitis as a major public health threat, a continued commitment to engaging underserved populations into the HCV care cascade is needed.

Introduction

In 2015, approximately 71 million people worldwide had chronic hepatitis C virus (HCV) infection, with as many as 80% of those infected lacking formal diagnosis.[1] In Europe, Germany has one of the highest numbers of HCV cases, estimated to be more than 200,000 individuals in 2016,[2] although the rate of newly diagnosed infections is low relative to the overall population.[3,4]

In 2011, the German Health Interview and Examination Survey for Adults, first wave (DEGS1; n = 7047) reported an anti-HCV antibody prevalence of 0.3% in the German general population.[5] However, true prevalence is likely higher because most newly diagnosed cases are in people who inject drugs (PWID), human immunodeficiency virus (HIV) coinfected men who have sex with men, and migrants, all populations underrepresented during DEGS1.[4–6]

The World Health Organization (WHO) set a global target of reducing new chronic HCV infections by 90%, and mortality from HCV by 65%, by the year 2030.[7] In 2016, Germany was ranked in the top 8 of 91 countries for treating patients with HCV (7%) and in the top 10 for net cure rate (5%).[8] However, data show substantial differences between number of patients diagnosed and those initiating treatment, indicating clear gaps in the care cascade.[6,8] Although Germany is currently predicted to meet WHO HCV elimination targets by 2030,[9] most countries are not expected to eliminate HCV until at least 2050.[10] The coronavirus disease 2019 (COVID-19) pandemic is set to hinder elimination efforts further, with many patients with HCV struggling to access testing or obtain treatments.[11]

Simplification of care has become increasingly important within the field of HCV treatment.[12] Historically, treating chronic HCV infection involved high levels of continuous care and the most at-risk populations struggled to adhere.[13] Since the approval of the first all-oral direct-acting antivirals (DAAs) in 2014, treatment durations have dropped to as few as 8 weeks.[14–19] Therefore, effective, short-term and well-tolerated treatment are available for patients previously unwilling or unable to access care. In the 4 years after introducing all-oral DAAs in Germany, there was a decrease in the proportion of patients with cirrhosis treated for HCV and an increase in patients with a history of drug use.[20] However, despite studies demonstrating that DAA treatment of former or current drug users is equally effective compared with patients with no history of drugs use,[21,22] treatment rates for PWID with chronic HCV in Germany remains low,[23] highlighting the need to expand HCV treatment within this population.

The German Hepatitis C-Registry (Deutsches Hepatitis C-Register, DHC-R) evaluates patient care among those with chronic HCV in Germany and investigates real-world effectiveness and safety of new treatment options.[20] Germany has no restrictions on access to chronic HCV treatment for diagnosed patients, in addition to universal reimbursement. Therefore, barriers to achieving HCV elimination are likely centred around reaching and engaging patients, particularly at-risk populations such as PWID.[24] Understanding the changing demographic and clinical characteristics of patients diagnosed with HCV allows for tailored, people-centred screening, diagnosis and treatment programs that increase awareness and linkage to care, ultimately helping to achieve HCV elimination targets.[24]

This study investigated changes in demographic and clinical characteristics of patients with HCV registered in the DHC-R from 2014 to 2019.

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