The Association Between Race/Ethnicity and the Effectiveness of Direct Antiviral Agents for Hepatitis C Virus Infection

Black race and Hispanic ethnicity were associated with lower rates of sustained virologic response (SVR) to interferonbased treatments for chronic hepatitis C virus infection, whereas Asian race was associated with higher SVR rates compared to white patients. We aimed to describe the association between race/ ethnicity and effectiveness of new direct-acting antiviral regimens in the Veterans Affairs health care system nationally. We identified 21,095 hepatitis C virus-infected patients (11,029 [52%] white, 6,171 [29%] black, 1,187 [6%] Hispanic, 348 [2%] Asian/ Pacific Islander/ American Indian/ Alaska Native, and 2,360 [11%] declined/ missing race or ethnicity) who initiated antiviral treatment with regimens containing sofosbuvir, simeprevir + sofosbuvir, ledipasvir/ sofosbuvir, or paritaprevir/ ombitasvir/ ritonavir/ dasabuvir during the 18-month period from January 1, 2014, to June 30, 2015. Overall SVR rates were 89.8% (95% confidence interval [CI] 89.2-90.4) in white, 89.8% (95% CI 89.0-90.6) in black, 86.0% (95% CI 83.7-88.0) in Hispanic, and 90.7% (95% CI 87.0-93.5) in Asian/ Pacific Islander/ American Indian/ Alaska Native patients. However, after adjustment for baseline characteristics, black (adjusted odds ratio 5 0.77, P < 0.001) and Hispanic (adjusted odds ratio = 0.76, P = 0.007) patients were less likely to achieve SVR than white patients, a difference that was not explained by early treatment discontinuations. Among genotype 1-infected patients treated with ledipasvir/ sofosbuvir monotherapy, black patients had significantly lower SVR than white patients when treated for 8 weeks but not when treated for 12 weeks. Conclusion: Direct-acting antivirals produce high SVR rates in white, black, Hispanic, and Asian/ Pacific Islander/ American Indian/ Alaska Native patients; but after adjusting for baseline characteristics, black race and Hispanic ethnicity remain independent predictors of treatment failure. Short 8-week ledipasvir/ sofosbuvir monotherapy regimens should perhaps be avoided in black patients with genotype 1 hepatitis C virus.