Author information
1
Acclaim Gastroenterology, JPS Health Network, 1500 S Main St., Fort Worth, TX, 76104, USA.
2
Center for Outcomes Research, JPS Health Network, 1500 S Main St., Fort Worth, TX, 76104, USA.
3
Department of Biostatistics and Epidemiology, UNT Health Science Center School of Public Health, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA.
4
Pharmacy Services Administration, JPS Health Network, 1500 S Main St., Fort Worth, TX, 76104, USA.
5
Center for Outcomes Research, JPS Health Network, 1500 S Main St., Fort Worth, TX, 76104, USA. rojha@jpshealth.org.
6
Department of Biostatistics and Epidemiology, UNT Health Science Center School of Public Health, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA. rojha@jpshealth.org.
Abstract
BACKGROUND:
Underserved populations have an unequal burden of HCV infections and poor outcomes with interferon-based treatments. Direct-acting antivirals have the potential to reduce these inequalities.
AIMS:
We aimed to estimate sustained virologic response (SVR) following treatment with sofosbuvir-based regimens for HCV infections among underserved individuals and summarize the frequency of SVR across published studies of underserved populations.
METHODS:
We used data from a clinical cohort of patients aged ≥ 18 years who initiated sofosbuvir-based regimens for HCV infection between February 2014 and June 2016 at an urban public hospital network that serves as the healthcare safety-net for Tarrant County, Texas. We estimated SVR with corresponding 95% confidence limits (CL). In addition, we systematically reviewed the evidence to identify other studies of direct-acting antivirals among underserved populations.
RESULTS:
Our study population comprised 435 patients. The majority of patients were aged ≥ 50 years (76%), male (52%), non-Hispanic White (54%), HCV genotype 1 (79%) and treated with ledipasvir/sofosbuvir (69%). Overall SVR was 89% (95% CL 86, 92%) and highest for ledipasvir/sofosbuvir (SVR = 95%, 95% CL 92, 97%). The reported SVR following direct-acting antivirals among 837 underserved patients from three other studies ranged between 90 and 99%.
CONCLUSIONS:
Our results suggest that direct-acting antivirals, particularly ledipasvir/sofosbuvir, are generally effective for achieving SVR among underserved patients with HCV infections and may help reduce inequalities in HCV prevalence and outcomes for this vulnerable population.