Study reveals potential challenges for scaling up of HCV therapy in UK

A large proportion of patients with chronic hepatitis C virus (HCV) infection in the UK have co-morbidities, hazardous use of drugs and alcohol and are taking medications that can potentially interact with HCV direct-acting antivirals (DAAs), according to research presented to 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.

DAAs have transformed the treatment of HCV and the prognosis of patients living with the infection.

However, many patients with HCV have other serious mental and physical health problems that require ongoing therapy and a large proportion also use illicit drugs and/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, co-morbidities, lifestyle hazards and use of common medications with possible drug interactions. Data were collected between March 2012 and October 2014 from 59 treatment centres 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 of patients (85%) were white. Most (59%) were infected with HCV via injecting drug use (IDU). However, the investigators note 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 of age to 37% among the over-60s.

Many patients abused drugs and/or alcohol. Heavy drinking was reported by 38% of patients; 54% were smokers; 25% used cannabis. Patients with a history of injecting drug use had a higher prevalence of alcohol/drug use compared to non-IDU patients (p < 0.001).

There was a high prevalence of co-morbidities. The most common were depression (26%), diabetes (11%), cancers (8%) and HIV co-infection (5%). Prevalence of all these co-morbidities was higher among IDU vs. non-IDU patients (p < 0.001).

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 40 and 59 years. The over 60s were the age group most likely to be taking anti-diabetics, immunosuppressants and statins. Use of antiretrovirals peaked among 40-59 year olds.

Use of all co-medications was higher among IDUs compared to non-IDUs (p < 0.001).

The investigators conclude that there is a high prevalence of co-morbidities among patients with chronic HCV infection in the UK. A large proportion of patients have problematic drug/alcohol use, and use of co-medications was also highly prevalent. Patients with a history of injecting drug use had an especially high prevalence of co-morbidities, drug and alcohol use and use of prescription medications. The researchers also commented on the age-related increases in prevalence of co-morbidity and use of co-medications, which they believe “highlights the increasing complexity of managing this condition.”