HCV treatment effective, but underutilized, studies show

Two recent studies reported on the effectiveness of and use of treatment for hepatitis C virus (HCV).

The first, an industry-funded study, found low rates of re-infection in people who inject drugs. Researchers studied 286 participants from the CO-STAR trial who were receiving opioid agonist therapy and were successfully treated for HCV. Patients were followed every 6 months for up to three years. Merck Sharp & Dohme Corp. was the primary funder. Results were published Aug. 9 by Annals of Internal Medicine.

Ten participants had a total of 11 re-infections, for a re-infection rate of 1.7 per 100 person-years. Six re-infections occurred within 24 weeks of completing treatment. Re-infection rates were higher among those who engaged in needle or syringe sharing during the previous 24 weeks. The authors noted that the 24-week period is important for optimizing treatment of opioid use disorder and for providing access to syringe programs and that strategies for HCV elimination should include efforts to address, prevent, and manage HCV re-infection.

The researchers added that HCV re-infection risk should be assessed at an individual level before direct-acting antiviral (DAA) therapy is initiated. At a population level, efforts to reduce primary and re-infection incidence require health care with universal access to programs for persons with both HCV infection and injection drug use.

A second study found that relatively few patients received DAA after testing positive for HCV, regardless of insurance status. Researchers used data from an administrative claims and encounters database to build a cohort of patients ages 18 to 69 years who had HCV infection diagnosed from January 2019 to October 2020 and were continuously enrolled in insurance for at least 60 days before and 360 days after diagnosis. The association between starting DAA treatment and sex, age, race, payor, and Medicaid restriction status was assessed. Results were published Aug. 9 by MMWR.

The prevalence of starting DAA within 360 days of the first positive HCV RNA test result among Medicaid, Medicare, and private insurance recipients was 23%, 28%, and 35%, respectively. Among those treated, 75%, 77%, and 84%, respectively, started treatment within 180 days of diagnosis. Treatment initiation was less common among those with Medicaid (adjusted odds ratio [aOR], 0.54; 95% CI, 0.51 to 0.57) and Medicare (aOR, 0.62; 95% CI, 0.56 to 0.68) than among those with private insurance.

Among those with Medicaid or private insurance, treatment was lower in adults ages 18 to 29 and 30 to 39 years compared with those ages 50 to 59 years. Among Medicaid recipients, lower odds of treatment initiation were found in states with Medicaid treatment restrictions (aOR, 0.77; 95% CI, 0.74 to 0.81) than in states without restrictions and among persons whose race was coded as Black or African American (aOR, 0.93; 95% CI, 0.88 to 0.99) or other race (aOR, 0.73; 95% CI, 0.62 to 0.88) than among those whose race was coded as White.

Few insured persons with diagnosed HCV receive timely DAA treatment, and disparities in treatment exist, the authors concluded, noting that unrestricted access to timely DAA treatment is critical to reducing HCV mortality, disparities, and transmission.

“Universal hepatitis C screening coupled with simplified treatment protocols should be integrated into primary care and other settings serving persons with hepatitis C, and the number of primary care providers treating hepatitis C expanded, especially Medicaid providers serving populations disproportionately affected by hepatitis C,” the authors wrote. “Increasing access to hepatitis C treatment to all populations, regardless of insurance type, is essential to reducing viral hepatitis-related disparities and achieving hepatitis C elimination.”