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Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study
Author(s) -
Janjua N. Z.,
Islam N.,
Wong J.,
Yoshida E. M.,
Ramji A.,
Samji H.,
Butt Z. A.,
Chong M.,
Cook D.,
Alvarez M.,
Darvishian M.,
Tyndall M.,
Krajden M.
Publication year - 2017
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12684
Subject(s) - medicine , pegylated interferon , hepatitis c , sofosbuvir , hepatitis c virus , ribavirin , gastroenterology , telaprevir , population , boceprevir , odds ratio , ledipasvir , immunology , virus , environmental health
Summary We evaluated the shift in the characteristics of people who received interferon‐based hepatitis C virus ( HCV ) treatments and those who received recently introduced direct‐acting antivirals ( DAA s) in British Columbia ( BC ), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV , or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon‐based treatments including pegylated interferon/ribavirin (Peg IFN / RBV ) with/without boceprevir or telaprevir, DAA s with RBV or Peg IFN / RBV , and newer interferon‐free DAA s. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon‐free DAA s (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAA s and RBV or Peg IFN / RBV . Compared to those receiving interferon‐based treatment, people with HIV co‐infection (adjusted odds ratio [ aOR ]: 2.96, 95% CI : 2.31‐3.81), cirrhosis ( aOR : 1.77, 95% CI : 1.45‐2.15), decompensated cirrhosis ( aOR : 1.72, 95% CI : 1.31‐2.28), diabetes ( aOR : 1.30, 95% CI : 1.10‐1.54), a history of injection drug use ( aOR : 1.34, 95% CI : 1.09‐1.65) and opioid substitution therapy ( aOR : 1.30, 95% CI : 1.01‐1.67) were more likely to receive interferon‐free DAA s. Socio‐economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR : 0.71, 95% CI : 0.58‐0.87) to receive DAA s. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV ‐co‐infected), although gaps remain for the socio‐economically marginalized populations.