Changes in Characteristics and Patterns of Chronic Hepatitis C Patients Referred for Directacting Antiviral Therapy

Abstract

Introduction: With the increase in Hepatitis C (HCV) screening particularly in baby-boomers cohort, it is expected that the characteristics of patients who seek Direct Acting Antiviral agent (DAA) therapy would change over time. In addition, the availability of highly effective DAA therapy and priority treatment approval given to F2 and F4 HCV cases could change the pattern of newly referred HCV cases. However, this change have not been well documented. Methods: We reviewed medical records of patients who were referred and evaluated for DAA therapy at our center from October of 2014 to March of 2017 for changes in average age, fibrosis score, HCV genotype, rate of DAA therapy approval and type of DAA approved. The trend was compared between insurance payer type (public vs commercial). Results: Between October of 2014 and March of 2017, a total of 1532 Chronic Hepatitis C (CHC) cases were referred to our center for DAA treatment evaluation. We found no difference in average age at time of referral over time (average age 57 years). Majority of cases has genotype 1a (63%) followed by genotype 1b (23%). Genotype 2 and 3 each account for 6% of new referred cases. Majority of cases has F2 to F4 fibrosis at the time of presentation. However, the proportion of CHC cases with F2 to F4 fibrosis has decreased from 97% to 67% over the years. While the majority HCV cases has public insurance at the time of DAA treatment evaluation, we found no difference in the proportion of cases with F2-F4 fibrosis or HCV genotype when compared with cases with commercial insurance. Conclusion: With the introduction of highly effective HCV DAA therapy, given the difficulty in DAA treatment approval for F0 and F1 fibrosis HCV cases and with the increase in newly identified HCV cases, the expectation is a change in referral trend towards HCV cases with milder liver disease / fibrosis. Our single center data supports that trend. However, we observed no change in the average age of newly referred HCV cases or proportion of HCV genotype over time. Examining multi-center or nation trend data will assist in HCV care planning as we move towards HCV elimination.Figure