Favorable Sustained Virologic Response Rates Using Direct-Acting Antiviral Therapies at a Large Safety-Net Hospital

Background. Direct-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C virus (HCV) infection. Objective. To evaluate the clinical effectiveness of DAA in a safety-net population. Methods. Retrospective cohort study including patients who received at least one dose of DAA for chronic HCV infection. Primary outcome was sustained virologic response (SVR) defined as undetectable viral load at least 12 weeks after treatment termination. Results. Notable patient (n=174) characteristics included: 58% racial/ethnic minority group members, 34% Medicaid or uninsured, and 51% cirrhosis. Overall, SVR was 87.4%, including 15 patients who were lost to follow-up and deemed treatment failures. Multivariate analysis significantly associated completion of therapy on time (OR 4.55, p=.009) and the presence of insurance (OR 7.25, p=0.008) with SVR. Conclusion. A favorable rate of SVR can be obtained in a safety-net population. The majority of treatment failure was due to patients being lost to follow-up.