Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination
Abstract Background Eliminating hepatitis C virus (HCV) infections is a goal set by the World Health Organization. This has become possible with the introduction of highly effective and safe direct-acting antivirals (DAA) but limitations remain due to undiagnosed HCV infections and loss of patients...
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2024-10-01
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| Online Access: | https://doi.org/10.1186/s12916-024-03699-z |
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| author | Dorota Zarębska-Michaluk Michał Brzdęk Olga Tronina Justyna Janocha-Litwin Marek Sitko Anna Piekarska Jakub Klapaczyński Anna Parfieniuk-Kowerda Barbara Sobala-Szczygieł Magdalena Tudrujek-Zdunek Łukasz Laurans Robert Flisiak |
| author_facet | Dorota Zarębska-Michaluk Michał Brzdęk Olga Tronina Justyna Janocha-Litwin Marek Sitko Anna Piekarska Jakub Klapaczyński Anna Parfieniuk-Kowerda Barbara Sobala-Szczygieł Magdalena Tudrujek-Zdunek Łukasz Laurans Robert Flisiak |
| author_sort | Dorota Zarębska-Michaluk |
| collection | DOAJ |
| description | Abstract Background Eliminating hepatitis C virus (HCV) infections is a goal set by the World Health Organization. This has become possible with the introduction of highly effective and safe direct-acting antivirals (DAA) but limitations remain due to undiagnosed HCV infections and loss of patients from the cascade of care at various stages, including those lost to follow-up (LTFU) before the assessment of the effectiveness of the therapy. The aim of our study was to determine the extent of this loss and to establish the characteristics of patients experiencing it. Methods Patients with chronic HCV infection from the Polish retrospective multicenter EpiTer-2 database who were treated with DAA therapies between 2015 and 2023 were included in the study. Results In the study population of 18,968 patients, 106 had died by the end of the 12-week post-treatment follow-up period, and 509 patients did not report for evaluation of therapy effectiveness while alive and were considered LTFU. Among patients with available assessment of sustained virological response (SVR), the effectiveness of therapy was 97.5%. A significantly higher percentage of men (p<0.0001) and a lower median age (p=0.0001) were documented in LTFU compared to the group with available SVR assessment. In LTFU patients, comorbidities such as alcohol (p<0.0001) and drug addiction (p=0.0005), depression (p=0.0449) or other mental disorders (p<0.0001), and co-infection with human immunodeficiency virus (HIV) (p<0.0001) were significantly more common as compared to those with SVR assessment. They were also significantly more often infected with genotype (GT) 3, less likely to be treatment-experienced and more likely to discontinue DAA therapy. Conclusions In a real-world population of nearly 19,000 HCV-infected patients, we documented a 2.7% loss to follow-up rate. Independent predictors of this phenomenon were male gender, GT3 infection, HIV co-infection, alcohol addiction, mental illnesses, lack of prior antiviral treatment and discontinuation of DAA therapy. |
| format | Article |
| id | doaj-art-2b3b1b2c568045c6bb363b56381eaabf |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-2b3b1b2c568045c6bb363b56381eaabf2024-11-10T12:28:59ZengBMCBMC Medicine1741-70152024-10-0122111110.1186/s12916-024-03699-zLoss to follow-up of patients after antiviral treatment as an additional barrier to HCV eliminationDorota Zarębska-Michaluk0Michał Brzdęk1Olga Tronina2Justyna Janocha-Litwin3Marek Sitko4Anna Piekarska5Jakub Klapaczyński6Anna Parfieniuk-Kowerda7Barbara Sobala-Szczygieł8Magdalena Tudrujek-Zdunek9Łukasz Laurans10Robert Flisiak11Department of Infectious Diseases and Allergology, Jan Kochanowski UniversityCollegium Medicum, Jan Kochanowski UniversityDepartment of Transplantology, Immunology, Nephrology and Internal Diseases, Medical University of WarsawDepartment of Infectious Diseases and Hepatology, Wrocław Medical UniversityDepartment of Infectious and Tropical Diseases, Jagiellonian UniversityDepartment of Infectious Diseases and Hepatology, Medical University of ŁódźDepartment of Internal Medicine and Hepatology, The National Institute of Medicine of the Ministry of Interior and AdministrationDepartment of Infectious Diseases and Hepatology, Medical University of BiałystokDepartment of Infectious Diseases and Hepatology, Medical University of Silesia in KatowiceDepartment of Infectious Diseases, Medical University of LublinDepartment of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical UniversityDepartment of Infectious Diseases and Hepatology, Medical University of BiałystokAbstract Background Eliminating hepatitis C virus (HCV) infections is a goal set by the World Health Organization. This has become possible with the introduction of highly effective and safe direct-acting antivirals (DAA) but limitations remain due to undiagnosed HCV infections and loss of patients from the cascade of care at various stages, including those lost to follow-up (LTFU) before the assessment of the effectiveness of the therapy. The aim of our study was to determine the extent of this loss and to establish the characteristics of patients experiencing it. Methods Patients with chronic HCV infection from the Polish retrospective multicenter EpiTer-2 database who were treated with DAA therapies between 2015 and 2023 were included in the study. Results In the study population of 18,968 patients, 106 had died by the end of the 12-week post-treatment follow-up period, and 509 patients did not report for evaluation of therapy effectiveness while alive and were considered LTFU. Among patients with available assessment of sustained virological response (SVR), the effectiveness of therapy was 97.5%. A significantly higher percentage of men (p<0.0001) and a lower median age (p=0.0001) were documented in LTFU compared to the group with available SVR assessment. In LTFU patients, comorbidities such as alcohol (p<0.0001) and drug addiction (p=0.0005), depression (p=0.0449) or other mental disorders (p<0.0001), and co-infection with human immunodeficiency virus (HIV) (p<0.0001) were significantly more common as compared to those with SVR assessment. They were also significantly more often infected with genotype (GT) 3, less likely to be treatment-experienced and more likely to discontinue DAA therapy. Conclusions In a real-world population of nearly 19,000 HCV-infected patients, we documented a 2.7% loss to follow-up rate. Independent predictors of this phenomenon were male gender, GT3 infection, HIV co-infection, alcohol addiction, mental illnesses, lack of prior antiviral treatment and discontinuation of DAA therapy.https://doi.org/10.1186/s12916-024-03699-zHCVLost to follow-upTreatmentDirect-acting antivirals |
| spellingShingle | Dorota Zarębska-Michaluk Michał Brzdęk Olga Tronina Justyna Janocha-Litwin Marek Sitko Anna Piekarska Jakub Klapaczyński Anna Parfieniuk-Kowerda Barbara Sobala-Szczygieł Magdalena Tudrujek-Zdunek Łukasz Laurans Robert Flisiak Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination BMC Medicine HCV Lost to follow-up Treatment Direct-acting antivirals |
| title | Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination |
| title_full | Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination |
| title_fullStr | Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination |
| title_full_unstemmed | Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination |
| title_short | Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination |
| title_sort | loss to follow up of patients after antiviral treatment as an additional barrier to hcv elimination |
| topic | HCV Lost to follow-up Treatment Direct-acting antivirals |
| url | https://doi.org/10.1186/s12916-024-03699-z |
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