Hepatitis C virus infection characteristics and treatment outcomes in Canadian immigrants

Dan Smyth,Curtis L Cooper,On Behalf Of The Canuhc Cohort ,Sergio Borgia,Alnoor Ramji,Alexander Wong,Jordan J Feld,Ed Tam,Brian Conway,Marie-Louise Vachon,Lisa Barrett,Sam Lee,Daniel Read

doi:10.1186/s12889-020-09464-0

Abstract

BackgroundThere are multiple obstacles encountered by immigrants attempting to engage hepatitis C virus (HCV) care and treatment. We evaluated the diversity and treatment outcomes of HCV-infected immigrants evaluated for Direct Acting Antiviral (DAA) therapy in Canada.MethodsThe Canadian Network Undertaking against Hepatitis C (CANUHC) Cohort contains demographic information and DAA treatment information prospectively collected at 10 Canadian sites. Information on country of origin and race are collected. Characteristics and outcomes (sustained virological response; SVR) were compared by immigration status and race.ResultsBetween January 2016 and May 2018, 725 HCV-infected patients assessed for DAA therapy were enrolled in CANUHC (mean age: 52.66 ± 12.68 years); 65.66% male; 82.08% White, 5.28% Indigenous, 4.64% South East Asian, 4.64% East Indian, 3.36% Black). 18.48% were born outside of Canada. Mean age was similar [immigrants: 54.36 ± 13.95 years), Canadian-born: 52.27 ± 12.35 years); (p = 0.085)]. The overall baseline fibrosis score (in kPa measured by transient elastography) was similar among Canadian and foreign-born patients. Fibrosis score was not predicted by race or genotype. The proportion initiating DAA therapy was similar by immigrant status (56.72% vs 49.92%). SVR rates by intent-to-treat analysis were similar (immigrants-89.47%, Canadian-born-92.52%; p = 0.575).ConclusionA diverse immigrant population is engaging care in Canada, initiating HCV antiviral therapy in an equitable fashion and achieving SVR proportions similar to Canada-born patients. Our Canadian experience may be of value in informing HCV elimination efforts in economically developed regions.

Highlights

There are multiple obstacles encountered by immigrants attempting to engage hepatitis C virus (HCV) care and treatment
Population The Canadian Network Undertaking against Hepatitis C (CANUHC) Cohort contains demographic and HCV Direct Acting Antiviral (DAA) treatment information prospectively collected since January 2016 at 10 Canadian-based, publicly funding clinic sites at which patients are referred for HCV evaluation and antiviral treatment
Of 725 HCV-infected patients assessed for DAA treatment between January 2016 and May 2018, 18.48% (n = 134) were born outside of the country (Table 1)

Summary

Introduction

There are multiple obstacles encountered by immigrants attempting to engage hepatitis C virus (HCV) care and treatment. We evaluated the diversity and treatment outcomes of HCV-infected immigrants evaluated for Direct Acting Antiviral (DAA) therapy in Canada. Hepatitis C Virus (HCV) afflicts around 71 million individuals worldwide and is responsible for an estimated 399,000 deaths per year [1]. Direct-acting antivirals (DAAs) consist of a short-duration, well tolerated oral drug regime which has proven to be a breakthrough in HCV treatment leading to sustained virologic response (SVR) rates of over 90% in patients with all viral genotypes [2]. Despite the ability of DAAs to reliably cure chronic infection, HCV remains wide-spread and underdiagnosed in Canada [3, 4]. Failure to diagnose and treat would undoubtedly increase the risk for developing complications of HCV including hepatocellular carcinoma (HCC), which is already three-fold more common in Canadian immigrant populations [9, 10]

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Results

Conclusion