Effect of Interferon-Free Regimens on Disparities in Hepatitis C Treatment of US Veterans
Effect of Interferon-Free Regimens on Disparities in Hepatitis C Treatment of US Veterans
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DOI：
10.1016/j.jval.2017.12.025
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发表时间：
2018-08-01
期刊：
影响因子：
4.5
通讯作者：
Owens, Douglas K.
中科院分区：
文献类型：
--
作者：
Barnett, Paul G.;Joyce, Vilija R.;Owens, Douglas K.
目的：确定丙型肝炎病毒（HCV）无干扰素治疗的实施是否覆盖了不太可能从早期治疗中获益的人群，包括基因型1型病毒或干扰素治疗禁忌症的患者，以及面临治疗差异的人群：非洲裔美国人，HIV合并感染患者和药物使用障碍患者。研究方法：美国退伍军人健康管理局（VHA）的电子病历被用来描述慢性HCV感染患者及其接受的治疗。采用竞争性事件考克斯回归法对206,544例慢性HCV患者的治疗开始时间进行了6年的研究，这些患者的特征包括病毒基因型、人口统计学特征以及合并的医学和精神疾病。结果如下：随着无干扰素治疗方案的出现，治疗比例从2010年的2.4%增加到2015年的18.1%，绝对增长了15.7%。基因型1病毒、对既往治疗反应差和肝病患者的增加幅度最大。在HIV合并感染（18.6%）、酒精使用障碍（11.9%）和药物使用障碍（12.6%）患者以及非洲裔美国人（13.7%）和西班牙裔（13.5%）患者中观察到治疗比例的绝对值大幅增加，这些患者不太可能接受含干扰素的治疗。VHA在2015年花费了9.62亿美元用于无干扰素治疗，占其运营预算的1.5%。结论：接受VHA治疗的HCV患者比例增加了7倍。VHA在以前治疗不足的人群中成功地实施了干扰素治疗，这可能成为社区护理标准。
Objectives: To determine whether implementation of interferon-free treatment for hepatitis C virus (HCV) reached groups less likely to benefit from earlier therapies, including patients with genotype 1 virus or contraindications to interferon treatment, and groups that faced treatment disparities: African Americans, patients with HIV coinfection, and those with drug use disorder. Methods: Electronic medical records of the US Veterans Health Administration (VHA) were used to characterize patients with chronic HCV infection and the treatments they received. Initiation of treatment in 206,544 patients with chronic HCV characterized by viral genotype, demographic characteristics, and comorbid medical and mental illness was studied using a competing events Cox regression over 6 years. Results: With the advent of interferon-free regimens, the proportion treated increased from 2.4% in 2010 to 18.1% in 2015, an absolute increase of 15.7%. Patients with genotype 1 virus, poor response to previous treatment, and liver disease had the greatest increase. Large absolute increases in the proportion treated were observed in patients with HIV co-infection (18.6%), alcohol use disorder (11.9%), and drug use disorder (12.6%) and in African American (13.7%) and Hispanic (13.5%) patients, groups that were less likely to receive interferon-containing treatment. The VHA spent $962 million on interferon-free treatments in 2015, 1.5% of its operating budget. Conclusions: The proportion of patients with HCV treated in VHA increased sevenfold. The VHA was successful in implementing interferon treatment in previously undertreated populations, and this may become the community standard of care.