Direct-Acting Antivirals Still Underutilized for HCV Care

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The treatment rate decreased from 64.8% to 61.2% after 2018.

While direct-acting antivirals (DAA) have transformed treatment for patients with hepatitis C virus (HCV), the use of the medications are underused, according to a new analysis.

A team, led by Vy H. Nguyen, BA, Division of Gastroenterology and Hepatology, Stanford University Medical Center, evaluated HCV treatment rates since the advent of direct-acting antivirals.

Currently, there are not a lot of data on HCV treatment rates in the US.

In the retrospective cohort study, the investigators identified data from the deidentified Optum Cliniformatics Data Mart Database between 2014-2021 for patients with HCV in the DAA and COVID-19 eras.


The investigators sought main outcomes of the treatment rate and changes over time, which was assessed with adjusted log-binomial regression. The outcomes also included factors associated with treatment, which were examined using multivariable logistic regression.

The study included 133,348 patients with HCV with a mean age of 59.7 years. Of this group, 26.8% (n = 38,180) had HCV RNA data, 53.1% (n = 20,777) of which had positive HCV RNA tests.

In addition, 65.2% (n = 13,214) of patients with positive HCV RNA tests were treated with direct-acting antivirals and 6456 of 6634 patients treated with DAAs achieved sustained virologic response.

Treatment Rates

The investigators also adjusted for age, sex, and race and ethnicity and found the treatment rate in 2018 was 0.5 times greater than the rate in 2014 (adjusted prevalence ratio, 1.50; 95% CI, 1.42-1.59).

However, the treatment rate decreased from 64.8% to 61.2% after 2018. This was particularly true after 2019, where the treatment rate decreased to less than 60% (P <.001).

The results also show the number of patients with viremic HCV between April 2020 and March 2021 decreased to 496 from 2761 and 3258 the previous 2 years.

There were some trends that resulted in better odds of direct-acting antiviral treatment.

Patients receiving care from a gastroenterologist or infectious disease specialist with advanced care practitioners, including nurse practitioners, physician assistants or clinical nurse specialists were independently associated with a greater chance of DAA treatment (aOR, 1.64; 95% CI, 1.07-1.50).

However, patients with decompensated cirrhosis and/or hepatocellular carcinoma were 31% less likely to be receive any treatment compared to individuals without those conditions (aOR, 0.69; 95% CI, 0.54-0.90).

“In this cohort study, less than two-thirds of insured patients with viremic HCV received DAA treatment, with declines in both the treatment rate and the number of viremic HCV diagnoses since 2019 and especially during the COVID-19 pandemic,” the authors wrote.

The results highlight a need to promote and utilize direct-acting antivirals for patients with HCV.

“Further efforts are needed to increase HCV diagnosis and treatment, especially for those with cirrhosis and HCC,” the authors wrote. “An urgent call for nationwide actions to improve access to DAA treatment, community outreach programs, and specialists through referral pipelines is needed in the United States to stay on track to meet the World Health Organization goal of reducing the burden of viral hepatitis with the eventual goal to eliminate viral hepatitis.”

The study, “Characteristics and Treatment Rate of Patients With Hepatitis C Virus Infection in the Direct-Acting Antiviral Era and During the COVID-19 Pandemic in the United States,” was published online in JAMA Network Open.