Delays and gaps in progressing through the hepatitis C virus cascade of care: An underserved safety-net hospital experience

Abstract

Background and ObjectiveWhile highly effective hepatitis C virus (HCV) therapies exist, gaps in the cascade of care remain. Disparities in the HCV cascade are prominent among underserved safety-net populations. We aim to evaluate the HCV cascade among an urban safety-net cohort of HCV patients.MethodsWe retrospectively evaluated adults with chronic HCV to determine rates of linkage to care (LTC), retention to care, and receiving HCV treatment from 2002 to 2018. Comparisons between groups utilized Chi-square testing; comparisons of median time to LTC and HCV treatment were evaluated with Student’s t-test and analysis of variance.ResultsAmong 600 chronic HCV patients (60.7% male, 20.7% non-Hispanic white, 49.2% African American, 92.5% treatment naïve, 26.8% cirrhosis), successful LTC within one year of HCV diagnosis was 57.7%, among which, 91.6% were successfully retained into care. In those with successful LTC, 72.6% received HCV treatment, 91.8% completed treatment, and 89% achieved SVR12. Women with HCV experienced longer delays from LTC to HCV treatment (331 vs. 206 days in men, P < 0.05), as did African Americans (280 vs. 165 days in non-Hispanic whites, P < 0.05). Compared to the non-Hispanic whites, HCV treatment was lower in African Americans (70.4% vs. 74.4%, P < 0.05).ConclusionWomen with HCV experienced significant delays along the HCV cascade, with median time of over 2 years from diagnosis to treatment. African Americans also experienced significant delays along the HCV cascade of care. However, sex and race/ethnicity were not found to be significant predictors of overall LTC or treatment.

Comprehensive succinylome analyses reveal that hyperthermia upregulates lysine succinylation of annexin A2 by downregulating sirtuin7 in human keratinocytes

“…PTMs are important components regulating microbial resistance and immunity. [29,30] New emerging evidences support that PTMs serve as interfaces between viruses, restriction factors, and cellular defense mechanisms, providing potential drug targets for future immunoregulatory therapy. [31] Many restriction factors of viruses, such as IFITM3/2, APOBEC, and SAMHD1, can be subjected to phosphorylation.…”

Case Report: Pulmonary sarcomatoid carcinoma complicating TP53 mutation treated successfully with Tislelizumab combined with Anlotinib—a case report

“…The liver injury was relieved after prednisone treatment, and the subsequent use of Nivolumab was not affected (Alkrekshi and Tamaskar, 2021). Therefore, in patients with chemotherapy and immunotherapy, attention should be paid to the reexamination of HBV-DNA and HCV-RNA when liver injury occurs (Gomes et al, 2020). It has been reported that patients with PSC tried antivascular therapy (Jin and Yang, 2020;Kong et al, 2020).…”

Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective

“…Downstream from screening, follow-up testing and linkage to care for viral hepatitis has been relatively poor amongst safety-net populations. In a retrospective analysis of 600 safety-net patients with chronic HCV between 2002 and 2018, only 57.7% were seen by HCV specialists within a year of diagnosis, though the vast majority (91.6%) were followedup after the initial visit [45]. In terms of follow-up laboratory testing, data from a San Francisco safety-net system found that 22.9% of HCV antibody-positive patients did not receive further testing for HCV RNA [46].…”

“…Fortunately, treatment for viral hepatitis is highly effective. Across multiple US SNHs, real-world studies report high sustained virologic response (SVR) rates for directacting anti-HCV (DAA) treatment in underserved populations with significant barriers to healthcare [45,46,[49][50][51][52]. Antiviral treatment for chronic HBV in safety-net settings has also been associated with a reduced risk of cirrhosis as well as morbidity and mortality [53].…”

“…After starting HCV treatment, loss-to-follow-up and non-completion rate range from 22 to 25% [55], and the completion of post-SVR HCC surveillance remains inadequate [56]. Some safety-net demographics found to have lower rates or delays in HCV treatment include those of a female sex, black people, Hispanics, and those with governmental or no insurance [45,57,58].…”