Abstract
Objectives
Methods
Results
Conclusions
Keywords
Introduction
Beguelin C, Suter A, Bernasconi E, et al. Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study. Liver Int [published online ahead of print July 25, 2017]. 〈doi:10.1111/liv.13528〉.
Spradling PR, Xing J, Rupp LB, et al. Uptake of and factors associated with direct-acting antiviral therapy among patients in the Chronic Hepatitis Cohort Study, 2014 to 2015. J Clin Gastroenterol [published online ahead of print June 5, 2017]. 〈doi:10.1097/MCG.0000000000000857〉.
Spradling PR, Xing J, Rupp LB, et al. Uptake of and factors associated with direct-acting antiviral therapy among patients in the Chronic Hepatitis Cohort Study, 2014 to 2015. J Clin Gastroenterol [published online ahead of print June 5, 2017]. 〈doi:10.1097/MCG.0000000000000857〉.
Methods
Cohort
Data Sources, Variables, and Data Set Structure
Statistical Analysis
Results

Characteristic | Percent |
---|---|
Age (y), mean ± SD | 56.8 ± 7.61 |
<50 | 10.6% |
50–59 | 56.9% |
60–69 | 28.5% |
70–79 | 2.9% |
80+ | 1.1% |
Sex, female | 2.8% |
Race | |
White | 59.1% |
African American | 36.7% |
Other | 4.2% |
Ethnicity, Hispanic | 5.6% |
Distance to VA primary care | |
<5 miles | 29.6% |
5–15 miles | 42.8% |
>15 miles | 27.6% |
Distance to VA tertiary care | |
<40 miles | 40.8% |
40–100 miles | 25.9% |
>100 miles | 33.3% |
HCV genotype 1 | 81.5% |
FIB-4 score | Median 1.88 IQR 1.29–3.01 |
<1.45 | 44.0% |
1.45–3.25 | 32.6% |
>3.25 | 23.4% |
Cirrhosis | 7.4% |
Decompensated cirrhosis | 0.9% |
Hepatocellular carcinoma | 1.0% |
History of liver transplant | 0.8% |
Recent liver transplant | 0.03% |
Treatment history | |
Treatment-naive (never received treatment) | 90.1% |
Previous treatment with null response | 5.1% |
Previous treatment with partial response | 4.3% |
Re-infection/relapse following treatment with SVR | 0.4% |
Alcohol use disorder | 24.1% |
Anemia (low hemoglobin level) | 9.0% |
Bipolar disorder | 6.3% |
Cancer (other than hepatocellular carcinoma) | 6.5% |
Myocardial infarction or congestive heart failure | 4.9% |
Chronic obstructive pulmonary disease | 16.4% |
Depression | 33.3% |
Dementia | 0.4% |
Diabetes without chronic complication | 22.8% |
Diabetes with chronic complication | 5.5% |
Drug use disorder | 26.6% |
Hemoglobinopathy | 0.1% |
Hepatitis B virus infection | 0.5% |
HIV-positive | 4.5% |
History of kidney transplant | 0.3% |
Neutropenia | 0.4% |
Pregnancy | 0.01% |
Psychosis | 8.7% |
PTSD | 17.8% |
Peripheral vascular disease | 4.6% |
Renal failure | 5.4% |
Retinopathy | 0.4% |
Schizophrenia | 5.8% |
Seizure | 0.1% |
Paralysis | 1.1% |
Stroke | 4.2% |
History of suicide attempt | 0.7% |
Thrombocytopenia | 3.3% |
Year entered cohort | |
2010 | 78.2% |
2011 | 6.8% |
2012 | 5.7% |
2013 | 4.8% |
2014 | 4.6% |
Risk periods, event rates, and costs by type of HCV treatment | Federal fiscal year | |||||
---|---|---|---|---|---|---|
2010 | 2011 | 2012 | 2013 | 2014 | 2015 | |
Cohort members alive during year | 161,422 | 169,272 | 174,177 | 176,749 | 178,037 | 169,484 |
Deaths per 100 person-years | 4.09 | 4.28 | 4.43 | 4.88 | 5.04 | 5.22 |
Number with chronic HCV infection | 161,422 | 167,672 | 171,564 | 171,701 | 171,748 | 161,837 |
Life-years of chronic HCV infection | 147,904 | 155,559 | 159,727 | 160,302 | 160,498 | 145,396 |
Treatment starts per 100 person-years of chronic HCV infection | ||||||
Interferon-containing treatment | 2.40 | 1.55 | 3.15 | 1.90 | 1.24 | 0.16 |
Interferon-free treatment | 2.30 | 18.12 | ||||
Total | 2.40 | 1.55 | 3.15 | 1.91 | 3.54 | 18.28 |
Treatment cost (’000s, US $2015) | ||||||
Interferon dual therapy | 8,055 | 12,250 | 5779 | 3673 | 2239 | 4563 |
Direct-acting antiviral with interferon therapies | 40,725 | 50,813 | 79,531 | 27,915 | ||
Interferon-free therapies | 179,525 | 961,990 | ||||
Total | 8,055 | 12,250 | 46,504 | 54,486 | 261,295 | 994,468 |

Characteristic | Interferon-free treatment | Interferon-containing treatment | Interferon-free vs. interferon-containing treatment | |||
---|---|---|---|---|---|---|
Absolute probability | Hazard ratio | Absolute probability | Hazard ratio | Difference in absolute probability | Relative hazard | |
Age (y) | ||||||
<50 | 14.98 | 0.88 (0.82–0.94) | 3.50 | 1.47 (1.40–1.56) | 11.47 | 0.60 (0.55–0.65) |
50–59 | 16.80 | Reference | 2.40 | Reference | 14.40 | Reference |
60–69 | 17.57 | 1.05 (1.03–1.08) | 1.82 | 0.76 (0.73–0.78) | 15.75 | 1.39 (1.33–1.45) |
70+ | 10.38 | 0.59 (0.55–0.62) | 0.37 | 0.15 (0.13–0.18)* | 10.01 | 3.81 (3.14–4.64) |
Sex | ||||||
Male | 16.74 | Reference | 2.04 | Reference | 14.70 | Reference |
Female | 17.26 | 1.04 (0.97–1.11) | 2.36 | 1.16 (1.07–1.26) | 14.90 | 0.89 (0.80–0.99) |
Race | ||||||
White | 17.51 | Reference | 2.18 | Reference | 15.33 | Reference |
African American | 15.54 | 0.87 (0.85–0.90) | 1.79 | 0.82 (0.78–0.85) | 13.75 | 1.07 (1.02–1.12) |
Other | 16.78 | 0.95 (0.90–1.01) | 2.04 | 0.94 (0.87–1.01) | 14.74 | 1.02 (0.92–1.12) |
Ethnicity | ||||||
Hispanic | 15.51 | 0.91 (0.87–0.96) | 2.02 | 0.99 (0.92–1.05) | 13.48 | 0.92 (0.85–1.00) |
Non-Hispanic | 16.84 | Reference | 2.05 | Reference | 14.79 | Reference |
Distance to VA primary care | ||||||
<5 miles | 16.12 | Reference | 1.84 | Reference | 14.29 | Reference |
5–15 miles | 16.19 | 1.00 (0.98–1.03) | 2.07 | 1.13 (1.09–1.17) | 14.12 | 0.89 (0.85–0.93) |
>15 miles | 16.94 | 1.06 (1.03–1.09) | 2.18 | 1.19 (1.14–1.24) | 14.77 | 0.89 (0.85–0.94) |
Distance to VA tertiary care | ||||||
<40 miles | 17.60 | Reference | 1.70 | Reference | 15.90 | Reference |
40–100 miles | 15.40 | 0.86 (0.84–0.89) | 2.08 | 1.23 (1.18–1.28) | 13.32 | 0.70 (0.67–0.74) |
>100 miles | 15.77 | 0.88 (0.86–0.91) | 2.39 | 1.41 (1.36–1.47) | 13.38 | 0.63 (0.60–0.66) |
HCV genotype | ||||||
Type 1 | 16.97 | 1.09 (1.06–1.12) | 1.97 | 0.82 (0.79–0.86) | 15.00 | 1.32 (1.26–1.38) |
Other | 15.77 | Reference | 2.38 | Reference | 13.39 | Reference |
FIB-4 score | ||||||
<1.45 | 16.44 | Reference | 2.11 | Reference | 14.33 | Reference |
1.45–3.25 | 12.20 | 0.72 (0.69–0.75) | 1.68 | 0.79 (0.76–0.83) | 10.52 | 0.91 (0.85–0.96) |
>3.25 | 21.62 | 1.37 (1.33–1.41) | 2.36 | 1.12 (1.07–1.17) | 19.26 | 1.22 (1.16–1.29) |
Cirrhosis | 26.11 | 1.87 (1.80–1.93) | 3.33 | 1.81 (1.72–1.90) | 22.77 | 1.03 (0.97–1.10) |
No cirrhosis | 15.23 | Reference | 1.86 | Reference | 13.37 | Reference |
Decompensated cirrhosis | 15.91 | 0.94 (0.87–1.02) | 0.81 | 0.39 (0.32–0.46) | 15.10 | 2.44 (1.99–3.00) |
No decompensated cirrhosis | 16.77 | Reference | 2.08 | Reference | 14.70 | Reference |
Hepatocellular carcinoma | 11.96 | 0.68 (0.63–0.73) | 1.53 | 0.74 (0.64–0.85) | 10.43 | 0.92 (0.78–1.08) |
No hepatocellular carcinoma | 16.91 | Reference | 2.06 | Reference | 14.85 | Reference |
History of liver transplant | 27.40 | 1.82 (1.67–1.97) | 2.35 | 1.15 (0.99–1.33) | 25.06 | 1.58 (1.33–1.87) |
No history of liver transplant | 16.62 | Reference | 2.05 | Reference | 14.58 | Reference |
Recent liver transplant | 22.90 | 1.44 (0.96–2.18) | 5.47 | 2.74 (1.60–4.72) | 17.42 | 0.53 (0.27–1.04) |
No recent liver transplant | 16.75 | Reference | 2.05 | Reference | 14.70 | Reference |
Treatment history | ||||||
Treatment-naive | 8.37 | Reference | 0.62 | Reference | 7.75 | Reference |
Previous treatment with null response | 15.98 | 2.10 (2.02–2.18) | 1.16 | 1.88 (1.78–1.97) | 14.82 | 1.12 (1.05–1.19) |
Previous treatment with partial response | 14.24 | 1.83 (1.77–1.89) | 1.49 | 2.42 (2.31–2.53) | 12.75 | 0.76 (0.71–0.80) |
Re-infection/relapse after SVR | 5.11 | 0.59 (0.47–0.74) | 0.52 | 0.83 (0.64–1.09) | 4.59 | 0.70 (0.50–0.99) |
Alcohol use disorder | 13.75 | 0.75 (0.73–0.78) | 1.80 | 0.85 (0.81–0.89) | 11.94 | 0.89 (0.84–0.94) |
No alcohol problem | 17.63 | Reference | 2.12 | Reference | 15.51 | Reference |
Anemia (low hemoglobin level) | 15.40 | 0.90 (0.86–0.94) | 1.90 | 0.92 (0.86–0.97) | 13.50 | 0.98 (0.91–1.06) |
No anemia | 16.93 | Reference | 2.07 | Reference | 14.86 | Reference |
Bipolar disorder | 18.63 | 1.14 (1.03–1.25) | 2.34 | 1.16 (1.01–1.32) | 16.29 | 0.98 (0.84–1.16) |
No bipolar disorder | 16.66 | Reference | 2.03 | Reference | 14.62 | Reference |
Cancer (other than hepatocellular carcinoma) | 16.24 | 0.96 (0.92–1.00) | 1.92 | 0.93 (0.87–1.00) | 14.32 | 1.03 (0.95–1.12) |
No nonliver cancer | 16.80 | Reference | 2.06 | Reference | 14.74 | Reference |
MI or CHF | 13.20 | 0.75 (0.71–0.80) | 1.45 | 0.69 (0.63–0.76) | 11.75 | 1.09 (0.97–1.22) |
No MI or CHF | 16.95 | Reference | 2.08 | Reference | 14.88 | Reference |
COPD | 16.04 | 0.94 (0.91–0.97) | 1.87 | 0.89 (0.85–0.93) | 14.17 | 1.05 (1.00–1.11) |
No COPD | 16.91 | Reference | 2.09 | Reference | 14.83 | Reference |
Depression | 17.88 | 1.12 (1.09–1.15) | 2.23 | 1.14 (1.10–1.18) | 15.66 | 0.98 (0.94–1.03) |
No depression | 16.19 | Reference | 1.96 | Reference | 14.23 | Reference |
Dementia | 8.71 | 0.48 (0.38–0.62) | 0.86 | 0.41 (0.25–0.68) | 7.85 | 1.17 (0.67–2.04) |
No dementia | 16.79 | Reference | 2.05 | Reference | 14.73 | Reference |
Diabetes without chronic complication | 17.48 | 1.07 (1.04–1.10) | 1.96 | 0.94 (0.90–0.98) | 15.52 | 1.14 (1.08–1.20) |
No diabetes without complication | 16.51 | Reference | 2.08 | Reference | 14.43 | Reference |
Diabetes with chronic complication | 16.35 | 0.97 (0.92–1.02) | 1.87 | 0.91 (0.83–0.99) | 14.48 | 1.07 (0.97–1.18) |
No diabetes with complication | 16.78 | Reference | 2.06 | Reference | 14.72 | Reference |
Drug use disorder | 14.43 | 0.80 (0.78–0.83) | 1.85 | 0.87 (0.84–0.91) | 12.57 | 0.92 (0.87–0.97) |
No drug dependence or abuse | 17.51 | Reference | 2.12 | Reference | 15.39 | Reference |
Hemoglobinopathy | 23.82 | 1.52 (1.15–2.00) | 2.04 | 0.99 (0.60–1.63) | 21.79 | 1.53 (0.87–2.69) |
No hemoglobinopathy | 16.75 | Reference | 2.05 | Reference | 14.70 | Reference |
Hepatitis B virus infection | 19.27 | 1.18 (1.02–1.36) | 2.44 | 1.20 (0.95–1.50) | 16.83 | 0.98 (0.75–1.29) |
No hepatitis B virus infection | 16.74 | Reference | 2.05 | Reference | 14.69 | Reference |
HIV-positive | 20.57 | 1.29 (1.24–1.35) | 1.94 | 0.94 (0.88–1.01) | 18.63 | 1.37 (1.26–1.49) |
Not HIV-positive | 16.51 | Reference | 2.06 | Reference | 14.46 | Reference |
History of kidney transplant | 18.00 | 1.09 (0.89–1.32) | 1.06 | 0.51 (0.32–0.81) | 16.94 | 2.12 (1.29–3.48) |
No history of kidney transplant | 16.75 | Reference | 2.05 | Reference | 14.70 | Reference |
Neutropenia | 20.98 | 1.30 (1.15–1.47) | 2.66 | 1.30 (1.09–1.57) | 18.32 | 1.00 (0.80–1.25) |
No neutropenia | 16.73 | Reference | 2.05 | Reference | 14.68 | Reference |
Psychosis | 15.11 | 0.88 (0.81–0.96) | 1.74 | 0.83 (0.74–0.94) | 13.37 | 1.06 (0.91–1.22) |
No psychosis | 16.90 | Reference | 2.08 | Reference | 14.82 | Reference |
PTSD | 18.20 | 1.13 (1.09–1.16) | 2.09 | 1.03 (0.98–1.07) | 16.11 | 1.10 (1.04–1.16) |
No PTSD | 16.43 | Reference | 2.04 | Reference | 14.39 | Reference |
PVD | 16.81 | 1.00 (0.95–1.06) | 1.80 | 0.87 (0.80–0.95) | 15.01 | 1.15 (1.04–1.28) |
No PVD | 16.75 | Reference | 2.06 | Reference | 14.69 | Reference |
Renal failure | 13.13 | 0.75 (0.71–0.79) | 1.52 | 0.73 (0.66–0.80) | 11.61 | 1.02 (0.91–1.14) |
No renal failure | 17.02 | Reference | 2.08 | Reference | 14.94 | Reference |
Retinopathy | 14.93 | 0.88 (0.74–1.04) | 1.97 | 0.96 (0.72–1.28) | 12.96 | 0.91 (0.65–1.27) |
No retinopathy | 16.76 | Reference | 2.05 | Reference | 14.71 | Reference |
Schizophrenia | 13.63 | 0.78 (0.74–0.83) | 1.27 | 0.61 (0.55–0.66) | 12.36 | 1.29 (1.16–1.44) |
No schizophrenia | 16.91 | Reference | 2.09 | Reference | 14.82 | Reference |
Seizure | 15.94 | 0.94 (0.57–1.57) | 1.37 | 0.66 (0.30–1.48) | 14.56 | 1.42 (0.55–3.69) |
No seizure | 16.76 | Reference | 2.05 | Reference | 14.71 | Reference |
Paralysis | 13.41 | 0.78 (0.69–0.87) | 1.10 | 0.53 (0.42–0.66) | 12.31 | 1.47 (1.14–1.89) |
No paralysis | 16.79 | Reference | 2.06 | Reference | 14.73 | Reference |
Stroke | 14.84 | 0.87 (0.82–0.92) | 1.66 | 0.80 (0.73–0.88) | 13.18 | 1.08 (0.96–1.21) |
No stroke | 16.85 | Reference | 2.07 | Reference | 14.78 | Reference |
History of suicide attempt | 13.76 | 0.80 (0.66–0.97) | 1.38 | 0.67 (0.53–0.84) | 12.38 | 1.20 (0.89–1.61) |
No history of suicide attempt | 16.77 | Reference | 2.05 | Reference | 14.72 | Reference |
Thrombocytopenia | 18.96 | 1.17 (1.11–1.22) | 1.94 | 0.94 (0.87–1.02) | 17.02 | 1.24 (1.12–1.36) |
No thrombocytopenia | 16.60 | Reference | 2.06 | Reference | 14.55 | Reference |
Conclusions
Spradling PR, Xing J, Rupp LB, et al. Uptake of and factors associated with direct-acting antiviral therapy among patients in the Chronic Hepatitis Cohort Study, 2014 to 2015. J Clin Gastroenterol [published online ahead of print June 5, 2017]. 〈doi:10.1097/MCG.0000000000000857〉.
Spradling PR, Xing J, Rupp LB, et al. Uptake of and factors associated with direct-acting antiviral therapy among patients in the Chronic Hepatitis Cohort Study, 2014 to 2015. J Clin Gastroenterol [published online ahead of print June 5, 2017]. 〈doi:10.1097/MCG.0000000000000857〉.
Beguelin C, Suter A, Bernasconi E, et al. Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study. Liver Int [published online ahead of print July 25, 2017]. 〈doi:10.1111/liv.13528〉.
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☆Conflicts of interest: No financial disclosures were reported by the authors of this article.
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