Category: Federal Forum Posters
Purpose: Hepatitis C virus (HCV), a chronic blood-borne pathogen, affects at least 3.6 million people in the United States. Data suggests HCV is more prevalent among Veterans compared to the general population. HCV transmission is elevated among individuals with substance use disorders (SUDs), leading to long-term health consequences. Early AASLD/IDSA guidelines excluded patients with SUD as candidates for HCV treatment due to non-adherence and reinfection risks. However, current guidelines recommend treatment in all patients, including those with SUD. Despite improved efficacy with newer oral antiviral therapies, HCV-related deaths are expected to increase if HCV-infected patients with comorbid SUD are not treated.
Methods: A retrospective cohort analysis will be conducted through electronic chart review in patients with hepatitis C and substance use disorder at the Providence VA Medical Center. The local Hepatitis C clinical case registry (CCR) will be used to identify patients treated from January 1, 2015 and September 30, 2018 in the pharmacy liver clinic. Patients will be included in the study if they initiated oral HCV direct-acting antivirals (DAAs) who
also have evidence of opioid agonist therapy, substance abuse, or positive alcohol/drug abuse screening at treatment initiation. Patients who were treated with the following DAAs will be included: sofosbuvir/velpatasvir, ledipasvir/sofosbuvir, elbasvir/grazoprevir, and glecaprevir/pibrentasvir. Patients will be excluded from the study if they were treated outside of the VA, treatment experienced, or on alternative HCV therapy. The primary outcome is sustained virologic response (SVR) at 12 or more weeks post-treatment. Secondary outcomes will consist of SVR with participation in treatment programs or social support groups, hepatitis C recurrence rates, medication compliance, and costs associated with reinfection. Other collected data will include: patient demographics, HCV genotype, HCV viral load, antiviral regimen and
duration, fibrosis-4 score, fibroscan, substance use, methadone or buprenorphine maintenance, and housing status.
Giuseppina Sclafani– Pharmacy Practice Resident, Providence VA Medical Center, Revere, MA