Real-World Clinical Efficacy and Tolerability of Direct-Acting Antivirals in Hepatitis C Monoinfection Compared to Hepatitis C/Human Immunodeficiency Virus Coinfection in a Community Care Setting

Gayam, Vijay; Hossain, Muhammad Rajib; Khalid, Mazin; Chakaraborty, Sandipan; Mukhtar, Osama; Dahal, Sumit; Mandal, Amrendra; Gill, Arshpal; Garlapati, Pavani; Ramakrishnaiah, Sreedevi; Khalid, Mowyad; Sherigar, Jagannath; Mansour, Mohammed; Mohanty, Smruti R.

doi:10.5009/gnl18004

Cited by 20 publications

(25 citation statements)

References 39 publications

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“…The treatment of HCV has shifted toward more tolerable, safer oral regimens with the use of direct-acting antiviral agents (DAAs). These regimens have truly revolutionized the efficiency of HCV treatment by achieving a sustained virologic response (SVR), shortening the duration of treatment, and improving patient outcomes without the burden of neuropsychiatric adverse effects [11,[16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Direct-Acting Antiviral Treatment of Psychiatric Patients with Comorbid Hepatitis C Virus Infection

Gayam

Jegede

Tiongson

et al. 2019

Dig Dis

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Background: The highest burden of hepatitis C virus (HCV) infection is seen in patients with psychiatric disorders who have been excluded from traditional treatments with Interferon due to treatment-emergent neuropsychiatric adverse effects. The goal of this study is to determine the tolerability, treatment retention, and efficacy of direct-acting antivirals with psychiatric disorders and comorbid substance use disorders in real-life settings. Methods: This is a retrospective cohort observational study of HCV patients treated with direct-acting antivirals between January 2016 and December 2018. Patients were stratified and sub-stratified based on their psychiatric diagnosis and substance use. The primary assessment was the sustained virologic response at 12 weeks post-treatment (SVR12). Results: Among the 291 patients analyzed, patients with psychiatric diagnosis and non-psychiatric patients made up 51.2% (n = 149) and 48.8% (n = 142) respectively. Majority of the patients included in the study were African-Americans (68.7%, n = 200). Overall, 95.3% (142/149) and 94.4% (134/142) of psychiatric and nonpsychiatric patients, respectively, achieved SVR12 and treatment response was similar between the groups (p = 0.72). Among psychiatric patients, only the prior treatment status was identified as a predictor of treatment response (OR 0.153, 95% CI 0.03-0.79; p = 0.05). No statistical difference was observed among the patients with SVR12 based on their primary psychiatric diagnoses or by comorbid substance abuse. Conclusion: The results of our study show that directacting antiviral treatments are well tolerated in psychiatric patients, and an overwhelming majority of patients achieved SVR12. Our study highlights the need to integrate HCV screening with treatment linkage in psychiatry and primary care practice.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Direct-Acting Antiviral Treatment of Psychiatric Patients with Comorbid Hepatitis C Virus Infection

Gayam

Jegede

Tiongson

et al. 2019

Dig Dis

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“…The SVR rates remained high even in patients with compensated cirrhosis, with a reported SVR of 92% in co-infected and cirrhotic patients The SVR was low with 8 weeks of therapy, and to achieve SVR of 92% patients required 12 weeks of treatment [47]. Community-based literature involving reiterate the idea that there may be a slightly diminished response in the HCV/ HIV co-infected cohort in real-world studies [48].…”

Section: Direct-acting Antivirals In Hcv/hiv Co-infected Patients Andmentioning

confidence: 99%

Direct-Acting Antivirals in Chronic Hepatitis C Infection with Liver Cirrhosis

Gayam¹,

Gill²,

Garlapati³

et al. 2020

Hepatitis B and C

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Chronic hepatitis C infection is a common cause of liver morbidity and mortality across the world, in part due to complications including cirrhosis and hepatocellular carcinoma. The advent of Direct-acting antiviral (DAA) therapy has the potential to change the outcome of HCV infection in the vast majority of patients. Unfortunately, the chronic nature of HCV infection means that many patients requiring directacting antiviral (DAA) therapy have already developed compensated cirrhosis. This chapter reviews the importance of DAAs in the treatment of HCV infection, particularly in patients with existing compensated cirrhosis. Both efficacy and safety are discussed as essential endpoints of DAA therapy. Decompensated cirrhosis, treatment failures, vitamin-D deficiency, HIV co-infection, and ethnic differences in the context of treatment response are also discussed in this chapter.

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“…Modern DAA‐based HCV therapy results in SVR rates >95% across all HCV genotypes and HIV coinfected patients . While the historic HCV treatment with pegylated interferon (PEGIFN) and ribavirin (RBV) showed only modest SVR rates and was limited by various patient characteristics, the introduction of DAAs now enables curative treatment at a favourable tolerability in HIV/HCV coinfected individuals including HIV+ patients with acute hepatitis C as well as patients with cirrhosis and prior HCV treatment failure …”

Section: Introductionmentioning

confidence: 99%

“…1,2, 15 While the historic HCV treatment with pegylated interferon (PEGIFN) and ribavirin (RBV) showed only modest SVR rates and was limited by various patient characteristics, [16][17][18][19] the introduction of DAAs now enables curative treatment at a favourable tolerability in HIV/HCV coinfected individuals including HIV+ patients with acute hepatitis C as well as patients with cirrhosis and prior HCV treatment failure. [20][21][22][23][24][25][26][27][28] Yet, the HCV-associated burden of disease remains high in HIV patients and efforts are needed to expand screening and treatment as well as provide education on risk factors for HCV transmission and effective treatment options. 1,11,[29][30][31][32][33][34] The unrestricted access to novel DAA-regimens in Vienna since September 2017 marked an important step towards the World Health Organization (WHO)-goal of HCV elimination by 2030.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

Schmidbauer

Chromy

Schmidbauer

et al. 2020

Liver International

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Background & Aims Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection is common in people who inject drugs (PWIDs). Recently, ‘high‐risk’ behaviour among men who have sex with men (MSM) has emerged as another main route of HCV transmission. We analysed temporal trends in HCV epidemiology in a cohort of Viennese HIV+ patients. Methods Hepatitis C virus parameters were recorded at HIV diagnosis (baseline [BL]) and last visit (follow‐up [FU]) for all HIV+ patients attending our HIV clinic between January 2014 and December 2016. Proportions of HIV+ patients with anti‐HCV(+) and HCV viraemia (HCV‐RNA(+)) at BL/FU were assessed and stratified by route of transmission. Results In all, 1806/1874 (96.4%) HIV+ patients were tested for HCV at BL. Anti‐HCV(+) was detected in 93.2% (276/296) of PWIDs and in 3.7% (31/839) of MSM. After a median FU of 6.9 years, 1644 (91.0%) patients underwent FU HCV‐testing: 167 (90.3%) of PWIDs and 49 (6.7%) of MSM showed anti‐HCV(+). Among 208 viraemic HCV‐RNA(+) patients at BL, 30 (14.4%) had spontaneously cleared HCV, 76 (36.5%) achieved treatment‐induced eradication and 89 (42.8%) remained HCV‐RNA(+) at last FU. Among 1433 initially HCV‐naive patients, 45 (3.5%) acquired de‐novo HCV infection (11.1% PWIDs/80.0% MSM; incidence rate (IR) 0.004%; 95% confidence interval [CI] 0.0%‐0.022%) and 14 had HCV reinfections (85.7% PWIDs/14.3% other; IR 0.001%; 95% CI 0.0%‐0.018%) during a median FU of 6.7 years (interquartile range 7.4). Conclusion Hepatitis C virus testing was successfully implemented in the Viennese HIV(+) patients. Anti‐HCV(+) prevalence remained stable in HIV+ PWIDs but almost doubled in HIV+ MSM. De‐novo HCV infection occurred mostly in MSM, while HCV reinfections were mainly observed in PWIDs. HCV treatment uptake was suboptimal with 42.8% remaining HCV‐RNA(+) at FU.

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Real-World Clinical Efficacy and Tolerability of Direct-Acting Antivirals in Hepatitis C Monoinfection Compared to Hepatitis C/Human Immunodeficiency Virus Coinfection in a Community Care Setting

Cited by 20 publications

References 39 publications

Outcomes of Direct-Acting Antiviral Treatment of Psychiatric Patients with Comorbid Hepatitis C Virus Infection

Outcomes of Direct-Acting Antiviral Treatment of Psychiatric Patients with Comorbid Hepatitis C Virus Infection

Direct-Acting Antivirals in Chronic Hepatitis C Infection with Liver Cirrhosis

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

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