Characteristics and Outcomes of Direct-Acting Antiviral-Experienced Patients with Hepatitis C Infection Undergoing Retreatment at an Essential Hospital in the United States
Alejandro De La Hoz, Amin Pooja, Anna Kancharla, Elissa M Schechter-Perkins, Glorimar Ruiz-Mercado, Marielle Baldwin, David Nunes, Jessica L TaylorAbstract
Background
Hepatitis C (HCV) guidelines recommend direct-acting antiviral (DAA) rescue regimens in cases of treatment failure, and first-line regimens are recommended for reinfection. In patients with barriers to follow-up after initial HCV treatment, it is difficult to determine if an HCV viremia represents failure or reinfection. Patients are often retreated with rescue regimens despite higher costs. We compared the outcome of first-line vs. rescue therapy among DAA-experienced patients whose prior outcome was indeterminate.
Methods
retrospective cohort study included DAA-experienced adults undergoing retreatment at a hospital in Massachusetts between January-2016 and May-2022. We used descriptive statistics to characterize the population. For patients with an indeterminate prior HCV treatment outcome, we compared the groups’ characteristics and outcomes.
Results
We included 112 DAA-experienced patients with HCV viremia. Mean age was 52 years (SD=12.2), 80.4% were male and 42.9% were white. Nearly 1 in 4 (25%) reported active substance use. Outcomes of prior DAA treatment included sustained virologic response at 12 weeks (SVR12) in 39.3% (n=44) and treatment failure in 31% (n=27.7). The prior treatment outcome was indeterminate in 33% (n=37). We compared the outcomes of patients with an indeterminate treatment outcome retreated with first-line vs. rescue therapy. SVR12 (66.7 vs. 52.7%), treatment failure (0% vs. 10.5%) and indeterminate outcome (33.3% vs. 36.8%) were similar among groups (p = 0.502).
Conclusion
Outcomes with first line DAAs were comparable to rescue medications for retreatment of DAA-experienced patients with an indeterminate prior treatment outcome. Our findings can help decrease treatment-level barriers for HCV treatment.