Factors Associated With Faster Time to Hepatitis C Treatment
The researchers found a significant difference in mean time to direct-acting antiviral agent treatment among participants with public insurance payers compared with private insurance payers.
For patients with hepatitis C virus (HCV)-HIV coinfection or HCV monoinfection, being seen at an infectious disease office setting, having a public insurance payer, and receiving an initial approval of a requested regimen are associated with faster time to treatment, according to results published in AIDS Care.
The study included participants with HCV-HIV coinfection and HCV monoinfection, with data taken from electronic medical records at the University of Connecticut Health Center between January 1, 2014, and March 1, 2016 (n=170).
The researchers used the Kaplan-Meier and Fisher's exact test to analyze the time from the prescription of a direct-acting antiviral agent to delivery to the participant. They included variables achieving a significance of P <.20 in a Cox regression model including age and race.
Of all the participants, 24.5% had HIV coinfection.
The most commonly prescribed medication was ledipasvir/sofosbuvir, which was prescribed in 66.1% of cases. Participants reported a high level of medication compliance (91.8%), with 90.6% of participants achieving sustained virological response.
The researchers found that the mean overall time to treatment was 32.6 days (range, 2-180 days; standard deviation, 32.2 days). Participants who received approval of the initial requested regimen had the shortest mean time to treatment (28.8 days), whereas those who were denied had the longest mean time to treatment (91.4 days; P <.01).
The researchers also found a significant difference in mean time to treatment among participants with public insurance payers (27.9 days) compared with private insurance payers (57.0 days; P <.01).
Participants who were treated in the Infectious Diseases office had a shorter time to treatment (mean, 25.8 days) compared with those treated in the Gastroenterology office (mean, 42.0 days; P <.01).
The results did not indicate significant differences in time to treatment based on sex, race, HIV status, fibrosis level, or sustained virological response.
"HCV therapy is a rapidly changing field with considerable heterogeneity in prescribing rules for [direct-acting antiretroviral] therapy," the researchers wrote. "Less restrictive guidelines may decrease the burden of the prescription approval process and allow for scale-up of HCV treatment."
Rice DP, Ordoveza MA, Palmer AM, et al. Timing of treatment initiation of direct-acting antivirals for HIV/HCV coinfected and HCV monoinfected patients [published online July 18, 2018]. AIDS Care. doi: 10.1080/09540121.2018.1499857