Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort

Abstract

Background and Aims In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia’s universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment. Methods 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR). Results At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29–0.61), male gender (adj-OR = 0.49, 95%CI 0.31–0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28–0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36–0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33–0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08–0.80). Consistent results were seen in cirrhotic sub-analysis. Conclusions Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-022-07483-y.

Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

“…Logistic MVA assessed factors associated with LTFU among First Nations Peoples. The final logistic multivariable model was determined based on the results of the bi-variable analysis but also taking into account our understanding of the relationships and dependencies among variables, their clinical relevance, our previous analysis of this cohort [6], and informed by a previous study on LTFU in HCV care population [16]. The final model included age, FIB-4 score, number of comorbidities assessed by the RxRisk, Year of HCV treatment initiation, and type of service.…”

“…Details of the OPERA-C study have been described previously [6]. Briefly, the OPERA-C study included Australian adults with HCV who initiated DAA therapy at one of 26 hospitals across Australia during Feb-2016 to Dec-2019.…”

Broadening and strengthening the health providers caring for patients with chronic hepatitis C may improve continuity of care

“…Details of the OPERA‐C study have been previously described 12 . Briefly, the OPERA‐C is a multicenter prospective study of adults with HCV who received DAA therapy during February 2016 to July 2021 in one of 26 centers across Australia (six states and one territory).…”