by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

May 24, 2022

Featured Literature:
Carson JM, Hajarizadeh B, Hanson J, et. al.  Retreatment for hepatitis C virus direct acting antiviral therapy virological failure in primary and tertiary settings: the REACH-C cohort.  J Viral Hepat.  2022 May 18.  doi: 10.1111/jvh.13705.  PMID: 35583922

This study assessed virological failure rates, HCV retreatment uptake, and outcomes across 33 primary and tertiary HCV care programs in the Australian REACH-C observational cohort (March 2016-June 2019).  Following initial treatment, 4.4% (n = 408) of individuals with known SVR12 outcome experienced virological failure (VF); early treatment discontinuation was reported in 28%.  Several factors including male gender, recent injection drug use, cirrhosis, and GT3 increased likelihood of VF.  Retreatment was initiated for 213 (52%) individuals: among those with VF identified in primary care, 46% were referred to tertiary care, and among those with VF identified in tertiary care, 8% were retreated in primary care.  Median time from identification of VF to retreatment decreased from 407 days (2016) to 152 days (2019).  Individuals without treatment discontinuation (n = 154) were most commonly retreated with SOF/VEL/VOX x 12 weeks (48%) whereas people with discontinuation (n = 59) were most commonly retreated with SOF/VEL x 12 weeks (34%) or GLE/PIB x 8 weeks (20%).  Per-protocol SVR12 for retreatment was 81% overall: rates were similar between primary care and tertiary care settings as well as by initial treatment discontinuation history.  33 individuals experienced second VF: cirrhosis increased likelihood of second VF while SOF/VEL/VOX retreatment decreased likelihood of second VF (retreatment setting and prescriber type were not associated with second VF).  Of 15 people retreated after second VF, SOF/VEL/VOX was the most commonly selected combination (73%) with subsequent per-protocol SVR12 of 90%.

Author’s Commentary:

May is Hepatitis Awareness Month, and this study highlights an occasionally overlooked aspect of HCV care: timely engagement with, and outcomes of, retreatment using effective pan-genotypic regimens.  The REACH-C cohort helps affirm the critical importance of unrestricted DAA prescribing and broad encouragement of primary care-based treatment.  [In this analysis, primary care services included general practices, community health clinics, sexual health services, drug and alcohol services, outreach services, telehealth services, Indigenous health services, mental health services, and prisons.]  Even with a high prevalence of cirrhosis among individuals with second VF, retreatment cure rates were encouraging.  On-treatment support for individuals with care navigation and/or case management needs should be delivered through low-threshold, multidisciplinary approaches: such interventions can help achieve improved HCV outcomes for people who might otherwise face challenges impacting medication adherence (e.g., homelessness, severe mental health disorders, substance use).

The author has no conflicts of interest to disclose.

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