Direct acting antiviral treatment of chronic hepatitis C in Denmark: factors associated with and barriers to treatment initiation

Christina Sølund, Sofie Hallager, Martin S. Pedersen, Ulrik Fahnøe, Anja Ernst, Henrik B. Krarup, Birgit T. Røge, Peer B. Christensen, Alex L. Laursen, Jan Gerstoft, Erika Bélard, Lone G. Madsen, Kristian Schønning, Anders G. Pedersen, Jens Bukh, Nina Weis*

*Corresponding author for this work

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    Abstract

    Objectives: We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark. Materials and Methods: In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause. Results: In 344 (49%) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38–3.28), previous treatment failure OR 2.58 (CI: 1.84–3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18–2.17). The most frequent reasons for not starting treatment among 356 (51%) patients were non-adherence to medical appointments (n = 107/30%) and ongoing substance use (n = 61/17%). Treatment failure with viral relapse occurred in 19 (5.5%) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59–12.91). Conclusions: In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.

    Original languageEnglish
    JournalScandinavian Journal of Gastroenterology
    Volume53
    Issue number7
    Pages (from-to)849-856
    Number of pages8
    ISSN0036-5521
    DOIs
    Publication statusPublished - 2018

    Keywords

    • Barriers to treatment
    • DAA
    • Direct Acting Antivirals
    • Factors associated with treatment
    • HCV
    • Hepatitis C virus
    • Liver cancer
    • Liver disease
    • Treatment initiation

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