A retrospective cohort analysis published in PLOS One demonstrated that in the early years of the direct-acting antiviral (DAA) era, less than 10% of people diagnosed with chronic hepatitis C virus (HCV) infection received treatment with DAAs and the median time to treatment initiation was 300 days.

HCV is the most common blood-borne infection in the United States; however, data are limited on the initiation and utilization of DAAs in patients with HCV. Thus, researchers used electronic medical records and chart review abstraction from the Indiana University Health database of HCV-infected individuals who were diagnosed with chronic HCV infection between January 1, 2014 and December 31, 2015 to evaluate treatment initiation, time to treatment, and real-world effectiveness of all-oral DAAs during their first 2 years of availability.

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The researchers found that of the 830 people who initiated DAA therapy during the 2-year observation period, the estimated incidence of treatment initiation was 8.8%±0.34% at the end of year 1 and 15.0%±0.5% at the end of year 2. They also found that the median time to initiating therapy was 300 days, with positive predictors of treatment initiation including age, prior HCV treatment, cirrhosis, and history of liver transplant. Factors that were negatively associated with treatment initiation included history of drug abuse, high baseline alanine aminotransferase levels, hepatitis B virus infection, and self-pay. Of 423 people in the evaluable population, 83.9% of people achieved a sustained virologic response.

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The investigators concluded that, “Expanding treatment eligibility criteria and reducing economic barriers should increase rates of treatment initiation and reduce time to treatment.” They added that, “Future studies, based on more recent treatment periods, are likely to demonstrate improved access to treatment and broadened treatment eligibility including individuals with less advanced disease.”

Disclosure: This clinical trial was supported by Merck & Co., Inc. Please see the original reference for a full list of authors’ disclosures.


Kwo PY, Puenpatom A, Zhang Z, Hui SL, Kelley AA, Muschi D. Initial uptake, time to treatment, and real-world effectiveness of all-oral direct-acting antivirals for hepatitis C virus infection in the United States: A retrospective cohort analysis. PLoS ONE. 2019;14(8):e0218759.