Most vulnerable HCV patient groups treated with direct acting antivirals achieve high response rates and gain quality of life – Data from the German Hepatitis C-Registry (DHC-R)

Background and Aims To reach micro-elimination in HCV-patients, the focus has to be on most vulnerable patient groups. To improve patient care we characterized treatment outcomes and quality of life (QoL) of these patients in a large prospective real world cohort.

Method The present analysis is based on 6849 patients with available data as of Jul 15, 2022 and comprises the following subgroups: active drug use (yes N=478; no N=6371), alcohol abuse (yes N=650; no N=6199), former/current homelessness (yes N=81, no N=6768), prison experience (yes N=140; no N=6709). Data on homelessness and prison experience have been obtained since Oct 2020. One patient can belong to several subgroups.

Results The majority of the patients with active drug use, alcohol abuse, former/current homelessness or prison experience were male (79-84%). Patients from vulnerable subgroups were significantly younger than patients not belonging to these subgroups (p<0.05). With 22 and 23%, respectively, significantly more patients with active drug and alcohol abuse suffered from psychiatric disorders than those without drug or alcohol abuse (12 and 11.8%, respectively; p<0.05). Lost-to-follow-up (LTFU) rates ranged between 31 and 46% in vulnerable subgroups and where higher after EOT than before EOT. In vulnerable subgroups, Intention-to-treat SVR rates ranged between 61% (active drug abuse) and 67% (alcohol abuse) and was mainly affected by high LTFU rates. In Per-Protocol-Analysis, the SVR rates ranged between 93% (active drug abuse) and 97% (alcohol abuse). According to QoL, all vulnerable subgroups benefited significantly from DAA therapy (p<0.05; [Fig. 1]). Patients with former/current homelessness benefited the most. Adverse events occurred in 19% (prison experience) to 32% (active drug abuse) of the patients. Serious adverse events occurred in a maximum of 5% in each patient group.

Fig. 1  Change in SF-36 scales from baseline (BL) to week 12/24 after end of treatment (EOT) according to each subgroup (+yes, -no; changes between timepoints were significant within each subgroup, p<0.05)

Conclusion Vulnerable patient groups responded well to DAA therapy but still need special attention shown by higher rates of LTFU. Although often living in precarious circumstances all these patients gained quality of life from baseline up to 24 weeks after EOT which is a good argument to make efforts to grant access to DAA therapy for these vulnerable patient groups.

Publication History

Article published online:
28 August 2023