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
  • 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.


    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.


    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.


    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


    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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