Author information
1School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK; Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, Scotland, UK. Electronic address: smcdonald4@nhs.net.
2School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK; Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, Scotland, UK.
3Edinburgh Royal Infirmary, Edinburgh Scotland, UK.
4Ninewells Hospital and Medical School, Dundee, Scotland, UK.
5Gartnavel General Hospital, Glasgow, Scotland, UK.
6Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK.
7Glasgow Royal Infirmary, Glasgow, Scotland, UK.
8Crosshouse Hospital, Kilmarnock, Scotland, UK.
9Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
10Monklands Hospital, Airdrie, Scotland, UK.
11Kirkcaldy Hospital, Kirkcaldy, UK.
Abstract
BACKGROUND AND AIMS:
The global burden associated with hepatitis C virus (HCV) infection has prompted a scale-up of antiviral therapy. Hitherto, no data existed on the impact of scaling-up on the characteristics of treated populations or on sustained viral response (SVR) rates. We assessed the country-wide scale-up of antiviral therapy in Scotland, a country which nationally monitors uptake of and response to HCV treatment METHODS: Data for patients initiated on combined pegylated interferon and ribavirin therapy at 13 specialist HCV clinics in 2001-2010 were extracted from the Scottish HCV Clinical Database (n=3895). Patient characteristics included age, genotype, PWID (people who inject drugs) status, prison referral, and diagnosed cirrhosis. Temporal trends in covariates and adjusted effects on SVR were examined via mixed-effects regression.
RESULTS:
The number of patients starting treatment increased from 237 in 2001-2002 to 1560 in 2009-2010, with an increasing trend in SVR from 44% to 57% over this period. For a given clinic, between 2001/2 and 2010 there was a decrease in the odds of those treated being diagnosed cirrhotic (odds ratio[OR]=0.84 per year), and increasing temporal trends for those treated being PWID (OR=1.08) and prison referral (OR=1.06). Adjusting for covariates, the proportion of a given clinic's patients achieving SVR was positively associated with the percentage PWID (OR=1.01 per percent increase; 95% confidence interval [CI]: 1.00-1.02) and genotype 2/3 (OR=1.03; 95% CI: 1.02-1.04).
CONCLUSIONS:
Despite changes in patient characteristics, a country-wide scale-up of antiviral therapy did not compromise SVR rates. Results are highly relevant to countries planning on scaling-up treatment, given the forthcoming availability of new interferon-free therapies.