Race and Gender Differences in the Use of Direct Acting Antiviral Agents for Hepatitis C Virus

Kanwal, Fasiha; Kramer, Jennifer R.; El–Serag, Hashem B.; Frayne, Susan M.; Clark, Jack A.; Cao, Yumei; Taylor, Thomas J.; Smith, Donna; White, Donna L.; Asch, Steven M.

doi:10.1093/cid/ciw249

Cited by 63 publications

(69 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, we found people with a history of drug use and those on OST showed a trend towards receiving DAAs, although it was not significant for DAAs+PegIFN/RBV. These findings are consistent with data from the United States on HIV co‐infection and advanced‐stage liver disease but not for drug use . In these studies, as well as in another study from Switzerland, people with a history of substance use were less likely to receive new DAAs .…”

Section: Discussionsupporting

confidence: 88%

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Janjua

Islam

Wong

et al. 2017

Journal of Viral Hepatitis

View full text Add to dashboard Cite

We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.

show abstract

Section: Discussionsupporting

confidence: 88%

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Janjua

Islam

Wong

et al. 2017

Journal of Viral Hepatitis

View full text Add to dashboard Cite

show abstract

“…Psychiatric co-morbidity was a rare reason for lack of treatment. We stratified the sample by race to determine the reasons underlying the racial disparity in treatment observed in this as well as previous analysis 15 , Table 3 displays the reasons among African American and whites who did not receive DAA treatment during the study timeframe. Whites had a higher proportion of documented alcohol abuse (22.6% vs. 12.7%) than African American patients (p=0.04).…”

Section: Resultsmentioning

confidence: 97%

Barriers to hepatitis C treatment in the era of direct‐acting anti‐viral agents

Lin

Kramer

White

et al. 2017

Aliment Pharmacol Ther

View full text Add to dashboard Cite

BACKGROUND Direct-acting antivirals (DAA) are safe, effective treatment of hepatitis C virus (HCV). Suboptimal linkage to specialists and access to DAAs are the leading barriers to treatment; however, data are limited. AIM Determine predictors of follow-up, receipt of DAAs, and reasons for the lack thereof. METHODS We used clinical data from retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow-up in HCV clinics and DAA treatment (during 12/1/2013–4/30/2015). We then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment. RESULTS We identified 84,221 veterans who were previously seen in HCV clinics during the pre-DAA era. Of these, 47,165 (56.0%) followed-up in HCV specialty clinics, 13,532 (28.7%) of whom received DAAs. Older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection, and psychiatric illness were predictors of follow-up. Alcohol/drug abuse and medical comorbidity were predictors of lack of treatment. Of the 905 prospectively recruited patients, 56.2% patients had a specialist visit and 28% received DAAs. Common reasons for lack of follow-up were relocation (n=148, 37.4%) and missed/cancelled appointments (n=63, 15.9%). Reasons for lack of treatment included waiting for newer therapy (n=99, 38.8%), co-morbidities (n=66, 25.9%), and alcohol/drug abuse (n=63, 24.7%). CONCLUSIONS Half of patients with established HCV care were followed-up in the DAA era and only 29% received DAAs. Targeted efforts focusing on patient and system-levels may improve the reach of treatment with the new DAAs.

show abstract

“…There is evidence, however, that African American patients receive DAAs less often than white patients. In one study of the veteran population with HCV seeking care in the VA system during the DAA era, Kanwal, et al found that black patients had 22% lower odds [Odds Radio (OR): 0.78; 95% CI: 0.73-0.84] of being treated with DAAs than white patients [22]. This difference persisted after adjustment for socioeconomic status, severity of liver disease, comorbidity and healthcare utilization.…”

Section: Potential Contributors To the Elevated Hcc Risk And Higher Mmentioning

confidence: 99%

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Ad¹

2017

Austin J Gastroenterol

View full text Add to dashboard Cite

Liver cancer remains an important cause of cancer mortality in the United States. Incidence of hepatocellular carcinoma (HCC), the most common histological cell type of liver cancer, has increased over the past 30 years. The statistics are particularly worrisome for African Americans. Their incidence of HCC far surpasses that of other races, particularly whites. Additionally, mortality for African Americans with HCC is also far worse. In a review of the literature, we found a stepwise progression of variables that may contribute to this observation. African Americans have the highest observed rates of infection with chronic hepatitis and are offered treatment less often for hepatitis C virus. The progression to cirrhosis is slower, which may complicate HCC surveillance. Regardless, they receive surveillance either biochemical or radiographic at a lower rate than patients of other races. Further, African Americans present at a more advanced stage and are referred for curative therapy less often. When African Americans do receive therapy, their outcomes are worse. Additional investigation is warranted as to whether differences in tumor biology may also play a role.

show abstract

Race and Gender Differences in the Use of Direct Acting Antiviral Agents for Hepatitis C Virus

Abstract: There were unexplained differences among HCV population subgroups in the receipt of new DAA treatment. Targeted interventions are needed for black patients and younger women.

Cited by 63 publications

References 31 publications

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Barriers to hepatitis C treatment in the era of direct‐acting anti‐viral agents

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Contact Info

Product

Resources

About