Research is needed on the difficult‐to‐cure population of hepatitis C virus patients with disability

Abstract

We read with interest the recent editorial discussing that even in the era of novel antiviral regimens, barriers will continue to persist to the safe and effective treatment of hepatitis C virus (HCV) for difficult-to-cure and difficult-to-treat patient populations. (1) In this letter, we bring specific attention to the need for future research on the difficult-to-cure vulnerable population of disabled patients infected with HCV, who are eligible for Medicare because of Social Security Disability Insurance and represent almost three-quarters of all Medicare patients diagnosed with HCV. (2) Disabled HCV patients are an understudied population that faces numerous known, but most likely exacerbated, barriers to screening, linkage to care, quality of care, and treatment. For example, lack of proper dissemination channels for preventive care information and inadequate training for health care providers to communicate with a population with special needs represent hurdles for providing quality care for the disabled. (3) This population suffers from diverse disabilities including blindness, deafness, mental retardation, and cerebral palsy, though how HCV management is conducted in patients with such impairments is rarely described in clinical trials or even real-world studies. Furthermore, patients with disabilities are at a markedly higher risk of substance abuse, which in the context of national trends of an emerging HCV epidemic due to prescription opioid abuse (4) puts them at an increased risk of HCV reinfection.Future research needs to better characterize and optimize the safety and effectiveness profile of interferon-free regimens in a heterogeneous population such as patients with disabilities. (1) For example, elevated rates of psychiatric and physical comorbidity as well as polypharmacy in this population put disabled HCV patients at risk of possible drug-drug interactions even while on interferon-free therapy. Furthermore, although findings show that clearing the virus with interferon-based therapy may reduce the incidence of some extrahepatic manifestations of HCV, (5) in our work we have detected no effect of interferon therapy of 24 weeks at reducing metabolic and vascular risk over a followup period of 2 years. This could likely be due to impaired effectiveness of interferon-based therapy at achieving viral clearance in this vulnerable population.