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AASLD 2015: Study Reveals Potential Challenges for Scaling Up Hepatitis C Therapy in the UK

A large proportion of people with chronic hepatitis C virus (HCV) infection in the UK have comorbidities, hazardous use of drugs and alcohol, and are taking medications that could potentially interact with HCV direct-acting antivirals (DAAs), according to research presented at the 2015 AASLD Liver Meeting in San Francisco. The investigators caution that clinicians "need to be aware" of the potential for interactions when choosing HCV treatment regimens.

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DAAs have transformed the treatment of hepatitis C and the prognosis of patients living with the infection. However, many people with HCV have other serious mental and physical health problems that require ongoing therapy, and a large proportion also use illicit drugs or alcohol. This means there is significant potential for interaction between HCV DAAs, other therapies, and for some patients, illicit drugs and alcohol. This could represent a challenge to the scaling-up of HCV therapy in the UK.

To see if this was the case, investigators from HCV Research UK designed a study involving adult patients with chronic HCV infection to describe their demographics, comorbidities, lifestyle hazards, and use of common medications with possible drug interactions. Data were collected between March 2012 and October 2014 from 59 treatment centers enrolled with the National HCV Research UK Biobank.

A total of 6278 patients were eligible for inclusion. The median age was 52 years. The majority (85%) were white. Most (59%) were infected with HCV via injection drug use. However, the investigators note that this is lower than the national prevalence, "raising questions about appropriate access to specialist care among this patient group." Approximately a quarter of patients (24%) had cirrhosis. Prevalence of cirrhosis increased with age, from 5% among those under 39 years to 37% among the over-60s.

Many patients had drug or alcohol use disorders. Heavy drinking was reported by 38% of patients, 54% were smokers, and 25% used cannabis. People with a history of injection drug use had a significantly higher prevalence of alcohol and drug use compared to non-IDUs.

There was a high prevalence of comorbidities in this population. The most common were depression (26%), diabetes (11%), cancers (8%), and HIV coinfection (5%). Prevalence of all these comorbidities was higher among injection drug users versus non-IDU patients.

The most commonly used co-medications were psychotropics such as antidepressants, opioids, and hypnotics (39%), followed by anti-diabetic drugs (9%), immunosuppressants (6%), statins (5%), and antiretrovirals (5%).

Use of psychotropic drugs was common in all age groups, but peaked among those aged between age 40 and 59. The over-60s were the age group most likely to be taking anti-diabetic drugs, immunosuppressants, and statins. Use of antiretrovirals peaked among 40-59 year olds. Use of all co-medications was higher among injection drug users compared to non-IDUs.

The investigators concluded that there is a high prevalence of comorbidities among people with chronic HCV infection in the UK. A large proportion of have problematic drug or alcohol use, and use of co-medications was also highly prevalent. Patients with a history of injection drug use had an especially high prevalence of comorbidities, drug and alcohol use, and use of prescription medications.

The researchers also commented on the age-related increases in prevalence of comorbidities and use of co-medications, which they believe "highlights the increasing complexity of managing this condition."

11/25/15

Reference

BE Hudson, W Irving, ST Barclay, et al. Co-morbidities and co-medications of patients with chronic hepatitis C (CHC) under specialist care in the UK -- challenges for scaling up HCV treatment? AASLD Liver Meeting 2015. San Francisco, November 13-17, 2015. Abstract 1140.