title: What is the impact of a country-wide scale-up in antiviral therapy on the characteristics and sustained viral response rates of patients treated for hepatitis C?
abstract: OBJECTIVE
  The global burden associated with hepatitis C virus (HCV) infection has prompted a scale-up of antiviral therapy. Hitherto, no data exist on the impact of scaling-up, on the characteristics of treated populations, or on sustained viral response (SVR) rates. We assessed the country-wide scale-up of antiviral therapy in Scotland, a country which nationally monitors uptake of and response to HCV treatment.
  
  
  METHODS
  Data for patients, initiated on combined pegylated interferon and ribavirin therapy at 13 specialist HCV clinics in 2001-2010, were extracted from the Scottish HCV Clinical Database (n=3895). Patient characteristics included age, genotype, PWID (people who inject drugs) status, prison referral, and diagnosed cirrhosis. Temporal trends in covariates and adjusted effects on a SVR were examined via mixed-effects regression.
  
  
  RESULTS
  The number of patients starting treatment increased from 237 in 2001-2002 to 1560 in 2009-2010, with an increasing trend in SVR from 44% to 57% over this period. For a given clinic, between 2001/2 and 2010 there was a decrease in the odds of those treated being diagnosed with cirrhosis (odds ratio [OR]=0.84 per year), and increasing temporal trends for those treated being PWID (OR=1.08) and prison referrals (OR=1.06). Adjusting for covariates, the proportion of a given clinic's patients achieving SVR was positively associated with the percentage of PWID (OR=1.01 per percent increase; 95% confidence interval [CI]: 1.00-1.02) and genotype 2/3 (OR=1.03; 95% CI: 1.02-1.04).
  
  
  CONCLUSIONS
  Despite changes in patient characteristics, a country-wide scale-up of antiviral therapy did not compromise SVR rates. Results are highly relevant to countries planning on scaling-up treatment, given the forthcoming availability of new interferon-free therapies.
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK. Electronic address: smcdonald4@nhs.net.
authors.forename: Scott A
authors.initials: SA
authors.lastname: McDonald
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK.
authors.forename: Hamish A
authors.initials: HA
authors.lastname: Innes
authors.affiliation: Edinburgh Royal Infirmary, Edinburgh, Scotland, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hayes
authors.affiliation: Ninewells Hospital and Medical School, Dundee, Scotland, UK.
authors.forename: John F
authors.initials: JF
authors.lastname: Dillon
authors.affiliation: Gartnavel General Hospital, Glasgow, Scotland, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mills
authors.affiliation: Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.affiliation: Glasgow Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Barclay
authors.affiliation: Crosshouse Hospital, Kilmarnock, Scotland, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Allen
authors.affiliation: Gartnavel General Hospital, Glasgow, Scotland, UK.
authors.forename: Ray
authors.initials: R
authors.lastname: Fox
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fraser
authors.affiliation: Monklands Hospital, Airdrie, Scotland, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kennedy
authors.affiliation: Kirkcaldy Hospital, Kirkcaldy, UK.
authors.forename: Diptendu
authors.initials: D
authors.lastname: Bhattacharyya
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012367:RNA, Viral / Q000235:genetics*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: Antiviral therapy; Hepatitis C virus; Pegylated interferon; Sustained viral response