This World Hepatitis Day, we are revisiting the BC Hepatitis Testers Cohort (BC-HTC), a dynamic cohort of everyone who’s been tested for hepatitis C (HCV) or HIV, or diagnosed with hepatitis B, HCV, HIV, or active tuberculosis in B.C. since 1990. It is led by CHÉOS Scientist Dr. Naveed Janjua.
Last year, we spoke with Dr. Janjua about the BC-HTC and how it is helping to inform HCV elimination efforts in Canada. This year, we take a look at some of the most recent research to result from the cohort. You can read the full paper, by clicking the hyperlinked title.
The impact of public access to new HCV medications
Sofosbuvir and ledipasvir/sofobuvir are newer antiviral agents for the treatment of HCV; however, they are high cost, with a once-a-day, eight- to 24-week treatment regimen costing around $60,000 per person. The BC-HTC assessed whether public coverage (access to the drugs through PharmaCare) would impact access and adherence to these treatments.
The study determined that public coverage increased public expenditure and access to treatment (uptake increased by 154 per cent) without reducing adherence. This result could be considered by public payers when allocating resources.
How does opioid agonist therapy affect HCV treatment initiation among drug users?
Dr. Janjua and team investigated the association between opioid agonist therapy (OAT) and HCV treatment initiation among 13,803 people who use drugs (PWUD) and live with chronic HCV in the BC-HTC.
Of the participants who were on OAT at the end of the study period (1992–2019), 47 per cent had started HCV treatment, compared with 22 per cent of PWUD not on OAT. While this shows that people currently on OAT are more likely to start HCV treatment, there’s still a substantial number of people on OAT not starting treatment. As such, providers should consider how they can support the integration of HCV and substance use care in order to increase treatment uptake.
The association between direct-acting antivirals for HCV and death
Direct-acting antivirals (DAAs) are a well-tolerated treatment for HCV patients, and are expected to reduce the rate of end-stage liver disease and death among this population. Using data from the BC-HTC, researchers evaluated the impacts of DAA treatment and resultant sustained virologic response (SVR) on all-cause and liver- and drug-related mortality risk in Canada.
Comparing data from 10,855 people treated with DAAs and 10,855 untreated people, the study team determined that SVR from DAAs significantly reduced the risk of all-cause, liver-, and drug-related mortality among people with HCV. However, the use of injection drugs, alcohol, and HIV or HBV coinfection increased the risk of drug-related mortality, so integrated service provision should be considered.
HCV reinfection rates among men who have sex with men
Men who have sex with men (MSM) are one of the higher-risk groups for HCV reinfection. Led by Dr. Prince Adu (BCCDC), and co-authored by Dr. Janjua, researchers used data from the BC-HTC to assess HCV reinfection rates in MSM who experienced spontaneous clearance (SC) of HCV and MSM who achieved treatment-based SVR following HCV infection.
The research, which included 1,349 MSM, revealed that HCV reinfection was more than twice as common among those with SC compared with SVR. It also indicated that problematic alcohol use, injection drug use, and HIV coinfection were drivers of HCV reinfection. This suggests that it may be beneficial to engage MSM in harm reduction and prevention services to curb HCV reinfection.
You can keep up with the BC-HTC by following their Twitter account.
