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Increased Screening & New Models of Care are Key. Association of Direct-Acting Antiviral Therapy With Liver and Nonliver Complications and Long-term Mortality in Patients With Chronic Hepatitis C
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HCV DAAs Mortality, Models of Community Screening/Care
We know HCV DAAs reduce mortality & restore life. But reaching the most marginalized populations remains a challenge. Key now is - screening must be increased & keeping patients in care is critical until SVR. The key now is to implement models of HCV screening & treatment that best reach the most difficult to reach populations, injection drug users. To that end here are 3 important models that work in SF & NY that represent the most current & idealized approaches as discussed in NATAP webinars, plus addressing HCV in women & pregnancy is a key concern often overlooked.
Addressing HCV across the Reproductive Life Span in Women: from data to joint decision-making
Watch here - Friday October 6th, 2023 - 1:30pm
Speaker: Tatyana Kushner, MD, MSCE Associate Professor, Division of Liver Diseases Department of Obstetrics, Gynecology and Reproductive Sciences Icahn School of Medicine at Mount Sinai
Community-Based Approaches to HCV Treatment
Watch here - Friday September 15th, 2023 - 1:30pm
Speaker: Jennifer Price, MD, PhD Associate Professor of Medicine, Division of GI/ Hepatology Director, UCSF Viral Hepatitis Center
An Update on the Elimination of HCV, Community Based Model
Watch here - Friday May 19th, 2023
Speaker: Anthony Martinez, MD, AAHIVS, FAASLD Associate Professor of Medicine, Jacobs School of Medicine University at Buffalo Medical Director, Hepatology Erie County Medical Center
Hepatitis C & Addiction Medicine
Watch here - Friday, July 14th, 2023
Speaker: Laura Maroldo, PA-C, AAHIVS Chief Physician Assistant West Midtown Medical Group, New York, NY
December 12, 2022
To our knowledge, this is the largest clinical study to date that comprehensively evaluates overall mortality and liver as well as nonliver outcomes associated with DAA treatment for patients with CHC. Of note, a significant reduction in mortality was found, even for patients without cirrhosis, a population previously considered to receive less benefit from an HCV cure than patients with cirrhosis. In these study findings, DAA treatment was associated with a reduced risk of both liver and extrahepatic outcomes, ie, HCC, liver decompensation, diabetes, CKD, CVD, nonliver cancer, and ultimately, overall survival. Because HCV treatment with a DAA regimen is well tolerated for nearly all patients, we believe these findings provide further support for universal HCV treatment coverage for all patients affected by HCV.
the 57% lower mortality rate we observed among treated vs untreated patients was aligned with results reported by a prospective study9 of approximately 10 000 adult patients with chronic HCV infection in 32 expert hepatologic centers in France. In that study, a significant decrease of 52% (aHR, 0.48; 95% CI, 0.33-0.70; P < .001) in all-cause mortality was noted in patients receiving DAAs compared with untreated patients.
In addition, this study provides data for lower risk of liver decompensation among DAA-treated patients, which is different from results of a study of patients from specialized liver centers9; this may be related to selection bias inherent in studies from tertiary care centers and those using smaller patient sample size.
Association of Direct-Acting Antiviral Therapy With Liver and Nonliver Complications and Long-term Mortality in Patients With Chronic Hepatitis C
Findings This cohort study of 245 596 adults with CHC found that DAA treatment (vs no treatment) was independently associated with a lower risk of mortality and liver (ie, hepatocellular carcinoma and decompensation) and nonliver (ie, diabetes, chronic kidney disease, cardiovascular disease, and nonliver cancer) outcomes.
Results The DAA-treated cohort (vs untreated) were older (mean [SD] age, 59.9 [10.8] vs 58.5 [13.0] years; P < .001); more likely to be male (25 060 [62%] vs 119 727 [58%] men; P < .001) and White (23 937 [59%] vs 115 973 [57%]; P < .001) individuals; and more likely to have diabetes (10 680 [26%] vs 52 091 [25%]; P < .001) or cirrhosis (17 971 [44%] vs 60 094 [29%]; P < .001). Comparing DAA-treated with untreated patients, the incidence (per 1000 person-years) of liver outcomes (eg, decompensation, 28.2 [95% CI, 27.0-29.4] vs 40.8 [95% CI, 40.1-41.5]; P < .001, and HCC in compensated cirrhosis, 20.1 [95% CI, 18.4-21.9] vs 41.8 [95% CI, 40.3-43.3]; P < .001) and nonliver outcomes (eg, diabetes, 30.2 [95% CI, 35.4-37.7] vs 37.2 [95% CI, 36.6-37.9]; P < .001; and chronic kidney disease, 31.1 [95% CI, 29.9-32.2] vs 34.1 [95% CI, 33.5-34.7]; P < .001) were significantly lower in treated patients. The all-cause mortality rates per 1000 person-years were also significantly lower in DAA-treated compared with untreated patients (mortality, 36.5 [95% CI, 35.4-37.7] vs 64.7 [95% CI, 63.9-65.4]; P < .001). In multivariable regression analysis, DAA treatment was independently associated with a significant decrease in the risk of liver (adjusted hazard ratio [aHR] for HCC, 0.73; decompensation, 0.36), nonliver (aHR for diabetes, 0.74; chronic kidney disease, 0.81; cardiovascular disease, 0.90; nonliver cancer, 0.89), and mortality outcomes (aHR, 0.43).
Conclusions and Relevance The findings of this retrospective cohort study indicate that DAA treatment for insured patients with CHC was associated with improved liver- and nonliver outcomes, and ultimately, with long-term overall survival.
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