2153. Hepatitis C (HCV) Treatment Experience with Direct Acting Antivirals (DAAs) in a Large Urban Clinic
Session: Poster Abstract Session: HIV/HCV Coinfection and Liver Disease
Saturday, October 29, 2016
Room: Poster Hall
Background:  DAAs have revolutionized the treatment of HCV with cure rates of 95-100%, lower pill burden, and minimal adverse effects. The Ruth M. Rothstein CORE Center hepatitis clinic provides specialty HCV services to both mono and HCV/HIV co-infected patients. Per clinic protocol, patients referred for treatment must have a checklist completed by the provider and consultation with the pharmacist to review benefits, labs, and drug interactions. Patients are followed monthly and all medications are dispensed to patients at their monthly follow-up for the duration of treatment. We assessed treatment outcomes among patients undergoing Fibroscan referred for DAA treatment.

Methods: We retrospectively reviewed our clinic database of all patients referred and treated for HCV with newly approved DAAs from February 2014 through March 2016. We analyzed results for patients on treatment for at least 4 weeks.

Results: A total of 258 HCV treatment referrals were made; 48 denied/ineligible for tx, 4 referred to study, 2 never started tx, and 31 pts recently started/waiting to start tx were not included. Of the 173 patients included in the analysis, 118 were male, 62.4% black, 17.9% Hispanic, and 17.3% white. Mean age of 57 (22-78) and 101 pts (58%) were coinfected with HIV. Median Fibroscan score of 12.1 (4.3-75) and 54% were cirrhotic. 43% of the patients had Medicaid and 36% Medicare. SVR12 data available on n=118. Majority of patients were treated with Harvoni® (n=129); 78/80 pts had SVR12 (97.5%); HIV+ 98 % and HIV- 96.7%. Another 17 pts had end of treatment (EOT) response and 22 pts were not detected (ND) or < 12 at week 4 and are awaiting SVR12 visit. For pts tx with Sof/Riba: 15/19 (79%) SVR12; 2 EOT response and 2 ND at Week 4. The 4 pts who relapsed were co-infected. 2 pts treated with Viekira Pak; 1 relapsed and 1 EOT response. 7/8 pts treated with Sim/Sof had SVR12 (87.5%), and 7/10pts tx with Peg/Sof/Riba had SVR12 and 1 EOT response. The 3 pts who relapsed were mono-infected.

Conclusion:  In our clinic cohort of predominantly minority patients, majority co-infected with HIV, > 90% of patients reaching SVR12 endpoint have achieved HCV cure despite the high prevalence of cirrhosis. A multidisciplinary team approach to monitor patient adherence may be a key contributor in achieving HCV cure. 

Sonia Vibhakar, PharmD, The Ruth M. Rothstein CORE Center, Cook County Health and Hospitals System, Chicago, IL, Oluwatoyin Adeyemi, MD, Ruth M Rothstein CORE Center, Cook County Health and Hospitals System (CCHHS) and Rush University Medical Center, Chicago, IL, Rebecca Goldberg, RN, CORE center, Chicago, IL, Kerianne Burke, MPH, Ruth M Rothstein CORE Center, CCHHS, Chicago, IL, Maureen Gallagher, NP, Ruth M Rothstein CORE Center, Chicago, Chicago, IL, Deborah Wolen, NP, CORE Center, chicago, IL, Benjamin Go, MD, Cook County Health and Hospitals System, Chicago, IL and Gregory Huhn, MD, MPHTM, Infectious Diseases, Ruth M Rothstein CORE Center, Chicago, IL

Disclosures:

S. Vibhakar, None

O. Adeyemi, None

R. Goldberg, None

K. Burke, None

M. Gallagher, None

D. Wolen, None

B. Go, None

G. Huhn, None

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