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Utility of Evaluating HCV in an Uninsured Population

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Abstract

Objectives

Although effective HCV treatment is available, it can be difficult to access for uninsured, urban patients. Our aim was to assess the utility of evaluation and outcomes in the uninsured with HCV when access to health care and treatment with triple therapy is provided.

Methods

We performed a retrospective review of consecutive patients referred for HCV from 2011 to June 2013 to an indigent HCV clinic. The primary outcomes were assessment of disease severity by noninvasive means and initiation of therapy.

Results

We identified 350 patients: mean age 50.6, 84 % with no insurance, 62 % men, 58 % black, 91 % HCV treatment naïve. Of these, 148 underwent liver biopsy and 68 % had F0–F1 and 10 % had F3–F4 fibrosis. FIB-4 and APRI were highly correlated (r = 0.9; p < .0001) and correctly classified patients by fibrosis strata (F0–F1, F2, and F3–F4; p = .0004). When combined, a FIB-4 ≤1.5 and APRI ≤0.5 correctly classified the absence of advanced disease in 97 % (p < .0001). Of those evaluated, 39 (11 %) went on to HCV treatment. Of those not in a clinical trial, 51 % completed treatment with SVR in 61 % with genotype 1 and 75 % in genotypenon-1. Of those not treated (n = 309), the most common reasons were mild disease (16 %), lost to follow-up (23 %), ongoing alcohol or substance abuse (24 %), and uncontrolled depression (10 %).

Conclusion

Noninvasive assessment can accurately exclude advanced fibrosis. Despite access to care, the utility of evaluating to initiate HCV treatment is low suggesting that eliminating the barrier to health care may not increase HCV treatment.

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References

  1. Salomon JA, Weinstein MC, Hammitt JK, Goldie SJ. Empirically calibrated model of hepatitis C virus infection in the United States. Am J Epidemiol. 2002;156:761–773.

    Article  PubMed  Google Scholar 

  2. Armstrong GL, Wasley A, Simard EP, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.

    Article  PubMed  Google Scholar 

  3. Louie KS, Laurent S, Forssen UM, et al. The high comorbidity burden of the hepatitis C virus infected population in the United States. BMC Infect Dis. 2012;12:86.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Ong JP, Collantes R, Pitts A, et al. High rates of uninsured among HCV-positive individuals. J Clin Gastroenterol. 2005;39:826–830.

    Article  PubMed  Google Scholar 

  5. Putka B, Mullen K, Birdi S, et al. The disposition of hepatitis C antibody-positive patients in an urban hospital. J Viral Hepat. 2009;16:814–821.

    Article  CAS  PubMed  Google Scholar 

  6. Chander G, Sulkowski MS, Jenckes MW, et al. Treatment of chronic hepatitis C: a systematic review. Hepatology. 2002;36:S135–S144.

    Article  PubMed  Google Scholar 

  7. Chung RT. A watershed moment in the treatment of hepatitis C. N Engl J Med. 2012;366:273–275.

    Article  CAS  PubMed  Google Scholar 

  8. Poordad F, McCone J Jr, Bacon BR, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;31(364):1195–1206.

    Article  Google Scholar 

  9. Jacobson IM, McHutchison JG, Dusheiko G, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364:2405–2416.

    Article  CAS  PubMed  Google Scholar 

  10. Bacon BR, Gordon SC, Lawitz E, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;23(364):1207–1217.

    Article  Google Scholar 

  11. Stepanova M, Kanwal F, El-Serag HB, et al. Insurance status and treatment candidacy of hepatitis C patients: analysis of population-based data from the United States. Hepatology. 2011;53:737–745.

    Article  PubMed  Google Scholar 

  12. Moirand R, Bilodeau M, Brissette S, et al. Determinants of antiviral treatment initiation in a hepatitis C-infected population benefiting from universal health care coverage. Can J Gastroenterol. 2007;21:355–361.

    PubMed Central  PubMed  Google Scholar 

  13. McGowan CE, Monis A, Bacon BR, et al. A global view of hepatitis C: physician knowledge, opinions, and perceived barriers to care. Hepatology. 2013;57:1325–1332.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Fusfeld L, Aggarwal J, Dougher C, et al. Assessment of motivating factors associated with the initiation and completion of treatment for chronic hepatitis C virus (HCV) infection. BMC Infect Dis. 2013;13:234.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–526.

    Article  PubMed  Google Scholar 

  16. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–1325.

    Article  CAS  PubMed  Google Scholar 

  17. Smith BD, Morgan RL, Beckett GA. Hepatitis C virus testing of persons born during 1945–1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med. 2012;157:817–822.

    Article  PubMed  Google Scholar 

  18. Lynn RB. Hepatitis C virus testing of persons born during 1945–1965. Ann Intern Med. 2013;158:704–705.

    Article  PubMed  Google Scholar 

  19. Bruno S, Stroffolini T, Colombo M, et al. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology. 2007;45:579–587.

    Article  CAS  PubMed  Google Scholar 

  20. Alberti A. Impact of a sustained virological response on the long-term outcome of hepatitis C. Liver Int.. 2011;31:18–22.

    Article  PubMed  Google Scholar 

  21. Veldt BJ, Heathcote EJ, Wedemeyer H, et al. Sustained virologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis. Ann Intern Med. 2007;147:677–684.

    Article  PubMed  Google Scholar 

  22. Backus LI, Boothroyd DB, Phillips BR, et al. A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol. 2011;9:509–516.

    Article  PubMed  Google Scholar 

  23. Chen EY, Sclair SN, Czul F, et al. A small percentage of patients with hepatitis C receive triple therapy with boceprevir or telaprevir. Clin Gastroenterol Hepatol. 2013;11:1014–1020.

    Article  CAS  PubMed  Google Scholar 

  24. Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. N Engl J Med. 2013;368:1859.

    Article  CAS  PubMed  Google Scholar 

  25. Kanwal F, White DL, Tavakoli-Tabasi S. Many patients with interleukin 28B genotypes associated with response to therapy are ineligible for treatment because of comorbidities. Clin Gastroenterol Hepatol.. 2014;12:327–333.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Surjadi M, Torruellas C, Ayala C, et al. Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Dig Dis Sci. 2011;56:213–219.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Smith JO, Sterling RK. Systematic review: noninvasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther. 2009;30:557–576.

    Article  CAS  PubMed  Google Scholar 

  28. Bonder A, Afdhal N, et al. Utilization of FibroScan in clinical practice. Curr Gastroenterol Rep. 2014;16:372.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Hepatology, Virginia Commonwealth University, 1200 E Broad St, West Hospital, Rm 1478, PO Box 980341, Richmond, VA, 23298-0341, USA

    Indira Donepudi, Angelo Paredes, Sarah Hubbard, Chadi Awad & Richard K. Sterling

Authors
  1. Indira Donepudi
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  2. Angelo Paredes
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  3. Sarah Hubbard
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  4. Chadi Awad
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  5. Richard K. Sterling
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Correspondence to Richard K. Sterling.

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Donepudi, I., Paredes, A., Hubbard, S. et al. Utility of Evaluating HCV in an Uninsured Population. Dig Dis Sci 60, 1092–1097 (2015). https://doi.org/10.1007/s10620-014-3416-8

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  • DOI: https://doi.org/10.1007/s10620-014-3416-8

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