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Title: Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort.
Austin Authors: Clark, Paul J;Valery, Patricia C;Strasser, Simone I;Weltman, Martin;Thompson, Alexander J;Levy, Miriam;Leggett, Barbara;Zekry, Amany;Rong, Julian;Angus, Peter W ;George, Jacob;Bollipo, Steven;McGarity, Bruce;Sievert, William;Macquillan, Gerry;Tse, Edmund;Nicoll, Amanda;Wade, Amanda;Chu, Geoff;Harding, Damian;Cheng, Wendy;Farrell, Geoff;Roberts, Stuart K
Affiliation: Gastroenterology and Hepatology
Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
Bathurst Liver Clinic Bathurst Hospital, Bathurst, NSW, Australia
QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, NSW, Australia
Hepatology Services, Nepean Hospital, Penrith, NSW, Australia
Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, NSW, Australia
Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia
Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, VIC, 3844, Australia
Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia
Gastroenterology Department, John Hunter Hospital, New Lambton, NSW, Australia
Gastrointestinal and Liver Unit, Monash Health, Melbourne, VIC, Australia
Liver Transplant Unit Sir Charles Gairdner Hospital, Nedlands Perth, WA, Australia
Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
Eastern Health, Box Hill, VIC, Australia
Barwon Health Liver Clinic University Hospital, Geelong, VIC, Australia
Orange Liver Clinic, Orange Hospital, Orange, NSW, Australia
Department of Gastroenterology & Hepatology, Lyell McEwin Hospital, Vale, SA, Australia
Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia
Gastroenterology & Hepatology Unit Canberra Hospital, Canberra, ACT, Australia
The Alfred Hospital, Melbourne, VIC, Australia
Issue Date: Jan-2023
Date: 2022
Publication information: Digestive Diseases and Sciences 2023; 68(1)
Abstract: In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia's universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment. 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR). At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29-0.61), male gender (adj-OR = 0.49, 95%CI 0.31-0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28-0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36-0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33-0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08-0.80). Consistent results were seen in cirrhotic sub-analysis. Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.
DOI: 10.1007/s10620-022-07483-y
ORCID: 0000-0002-1821-4969
Journal: Digestive Diseases and Sciences
PubMed URL: 35552941
PubMed URL:
Type: Journal Article
Subjects: Cirrhosis
Data linkage
Liver fibrosis
Patient adherence
Sustained viral response
Appears in Collections:Journal articles

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