468. Outcomes of Direct-Acting Antivirals for Hepatitis C in an Indigent Population
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDSA2016_singlecenter_final.pdf (2.5 MB)
  • Background:

    Direct-acting antivirals (DAAs) have revolutionized the management of chronic hepatitis C (HCV). However, there are limited real-world data regarding HCV treatment outcomes, particularly among indigent populations. The aim of our study was to examine clinical outcomes of DAA-treated HCV-infected patients at an urban safety-net health system.

    Methods:

    We conducted a retrospective study of patients who started DAA-based, interferon-free HCV treatment between April 2014 and April 2016 at Parkland Health and Hospital System, the safety net health system of Dallas, TX.

    Results:

    Over a 2-year period, 390 patients were started on DAAs. Median age was 58 [IQR 54-62], 55% were male, and our cohort was racially diverse (42% White, 40% Black, 14% Hispanic, 4% Asian). 59% of patients had cirrhosis, 18% were treatment-experienced, 10% had HIV co-infection and 3% were liver transplant recipients. Sustained viral response (SVR) 12 weeks after treatment completion was available for 228 patients at time of abstract submission. SVR was achieved in 82% by intention-to-treat and 92% by protocol analysis (n=187). Viral relapse was observed in 5% (n=11), 2% stopped treatment due to death (n=2) or adverse effects of therapy (n=3), and 11% (n=25) were lost to follow-up. Of the 11 relapsers, 8 reported medication non-compliance. Post-treatment resistance mutation testing performed in 1 of 3 compliant relapsers confirmed NS5A drug resistance. Among 48 patients with clinical outcomes data available 1 year post-treatment, there were no deaths, 1 patient required hospitalization for liver-related complications, and 1 patient was able to discontinue diuretics without recurrence of ascites.

    Conclusion:

    This real-world study of DAA therapy at a large urban hospital demonstrated high cure rates (92% per protocol). Medication non-compliance was the main cause of viral relapse in this safety-net patient population, suggesting that interventions to improve adherence may decrease relapse rates. Nevertheless, access to and effectiveness of HCV DAAs were high in our safety-net hospital, suggesting that favorable outcomes can be achieved in real-world resource-limited settings.

    Carolina De La Flor, MD, Christina Yek, MD, Amit Singal, MD and Mamta Jain, MD, University of Texas Southwestern, Dallas, TX

    Disclosures:

    C. De La Flor, None

    C. Yek, None

    A. Singal, Gilead: Grant Investigator , Grant recipient

    M. Jain, Gilead Sciences: Grant Investigator and Investigator , Research grant
    AbbVie: Investigator , Research grant
    Merck: Grant Investigator , Research grant
    Bristol Myers Squibb: Investigator , Research grant
    Janssen: Investigator , Research grant

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