Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus

Abstract

Background Little is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH). Methods We conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure. Results Between January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29). Conclusions People living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.

Predictors of hepatitis C treatment outcomes in a harm reduction-focused primary care program in New York City

“…Other studies have found alcohol use, illicit drug use, and mental illness to be associated with HCV treatment non-completion; however these findings were not replicated in our study [ 21 , 24 , 40 ]. The unique structure of our program, which operates with an emphasis on educating and supporting our patients with alcohol and substance use disorders based on structured psychosocial assessment, may play a role in the lack of association of these exposures with treatment non-adherence.…”

“…In the wake of treatment innovations, such as DAAs and improved access to community-based care for SUD and HCV treatment in non-specialized settings, there has been significant progress and evidence of comparable cure rates being achieved in people who inject drugs as compared to other patient groups in clinical trials [18][19][20][21]. Despite these advances, there remains evidence of suboptimal treatment adherence and clinical outcomes among some groups of HCV patients, including persons with active IDU or HIV co-infection, as a complex array of clinical and psychosocial barriers continues to deter treatment success in real world cohorts of these historically vulnerable populations [22][23][24][25][26].…”

Effectiveness and safety of direct‐acting antivirals in hepatitis C infected patients with mental disorders: Results in real clinical practice

“…The results of our study show that these follow up losses in the group of psychiatric vs nonpsychiatric patients must be attributed to MDSDU‐patients and not to patients with other psychiatric disorders. These results reinforce the importance of care in integrated multidisciplinary health systems for the treatment of psychiatric patients, as is currently recommended, since they promote clinical adherence and improve the likelihood of achieving SVR in this subgroup of patients 47‐49 . The results of our study are in line with those reported in similar studies, in which the SVR12 reached with DAAs in patients with psychosocial comorbid conditions, substance use, mental health disorders, psychiatric disease or illicit drug use, was found among the 90%‐96% 50‐54 .…”

“…These results reinforce the importance of care in integrated multidisciplinary health systems for the treatment of psychiatric patients, as is currently recommended, since they promote clinical adherence and improve the likelihood of achieving SVR in this subgroup of patients. [47][48][49] The results of our study are in line with those reported in similar studies, in which the SVR12 reached with DAAs in patients with psychosocial comorbid conditions, substance use, mental health disorders, psychiatric disease or illicit drug use, was found among the 90%-96%. [50][51][52][53][54] Of particular interest are the results observed by A high and very similar global therapeutic safety has been observed in the group of psychiatric patients vs nonpsychiatric patients, with very similar incidence rates of mild, moderate, or severe adverse effects reported by the patients, as well as visits to the emergency room or treatment withdrawals secondary to the development of serious adverse effects.…”

Pangenotypic direct acting antivirals for the treatment of chronic hepatitis C virus infection: A systematic literature review and meta-analysis

“…This observation has been acknowledged by international guidelines [131]. However, consideration of this sub-population is still warranted given evidence suggesting that persons with HIVÀHCV coinfection are at risk of HCV treatment failure for factors such as ongoing illicit drug use and mental illness [132]. Analyses of harms suggest consistency across treatments for the very low proportions of persons with DAEs, SAEs, or all-cause mortality.…”