Racial/ethnic and socioeconomic disparities exist in DAA initiation. Substance use may also influence patient or provider decision making about DAA initiation. Strategies are needed to ensure equitable access to DAAs, even in insured populations.

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Background: Chronic hepatitis C virus (HCV) infection is a leading cause of liver cancer. The association of HCV infection with extrahepatic cancers, and the impact of direct-acting antiviral (DAA) treatment on these cancers, is less well known. Methods: We conducted a cohort study in a healthcare delivery system. Using electronic health record data from 2007 to 2017, we determined cancer incidence, overall and by type, in people with HCV infection and by DAA treatment status. All analyses included comparisons with a reference population of people without HCV infection. Covariate-adjusted Poisson models were used to estimate incidence rate ratios. Results: 2,451 people with HCV and 173,548 people without HCV were diagnosed with at least one type of cancer. Compared with people without HCV, those with HCV were at higher risk for liver cancer [adjusted incidence rate ratio (aIRR) = 31.4, 95% confidence interval (CI) = 28.9–34.0], hematologic cancer (aIRR = 1.3, 95% CI = 1.1–1.5), lung cancer (aIRR = 1.3, 95% CI = 1.2–1.5), pancreatic cancer (aIRR = 2.0, 95% CI = 1.6–2.5), oral/oropharynx cancer (aIRR = 1.4, 95% CI = 1.1–1.8), and anal cancer (aIRR = 1.6, 95% CI = 1.1–2.4). Compared with people without HCV, the aIRR for liver cancer was 31.9 (95% CI = 27.9–36.4) among DAA-untreated and 21.2 (95% CI = 16.8–26.6) among DAA-treated, and the aIRR for hematologic cancer was 1.5 (95% CI = 1.1–2.0) among DAA-untreated and 0.6 (95% CI = 0.3–1.2) among DAA-treated. Conclusions: People with HCV infection were at increased risk of liver cancer, hematologic cancer, and some other extrahepatic cancers. DAA treatment was associated with reduced risk of liver cancers and hematologic cancers. Impact: DAA treatment is important for reducing cancer incidence among people with HCV infection.

In an observational study of patients who received ledipasvir and sofosbuvir treatment for HCV genotype 1 infection, we found that contrary to guidelines, 8-week and 12-week treatment regimens do not result in statistically significant differences in SVR12 in black patients. Patient characteristics were associated with receipt of 12-week regimens among patients eligible for 8 weeks, but were not associated with reduced SVR12 after 8 weeks. Shorter treatment courses might therefore be more widely used without compromising treatment effectiveness.

U.S guidelines recommend that patients coinfected with HIV and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over 3 years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) vs. commercial insurance (aRR=0.62, 95% CI=0.46-0.84), patients with drug abuse diagnoses (aRR=0.72, 95% CI=0.54-0.97), patients with CD4 count <200 vs. ≥500 (aRR=0.45, 95% CI=0.23-0.91) and patients without prior HCV treatment (aRR=0.68, 95% CI=0.48-0.97). There were no significant differences in DAA initiation by age, sex, race/ethnicity, socioeconomic status, HIV-transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, ART use, hepatitis B infection, or number of outpatient visits. 95% of patients achieved SVR. We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 count, and patients receiving first-time HCV treatment.