title: Sofosbuvir-Containing Regimens for Chronic Hepatitis C Are Successful in the Safety-Net Population: A Real-World Experience.
abstract: Vulnerable populations are disproportionately affected by hepatitis C virus (HCV) infection and experience high rates of health disparity. There are no data on real-world experience with highly efficacious direct-acting anti-HCV treatment in this population.
  
  
  
  We aimed to evaluate the real-world experience with sofosbuvir-based regimens among a vulnerable HCV-infected population.
  
  
  
  HCV treatment response was assessed among 204 patients who completed 12-24 weeks of sofosbuvir-based regimens (in combination with pegylated interferon and ribavirin, simeprevir, ledipasvir, or daclatasvir) at the San Francisco safety-net healthcare system liver specialty clinic between January 2014 and December 2015. Virologic response during therapy was assessed at weeks 4 and 8, end of therapy, and 12-week treatment discontinuation (SVR 12).
  
  
  
  Patient characteristics were median age 58 years, 60 % male, 42 % Caucasian (21 % black, 19 % Hispanic), 72 % had genotype 1 (23 % genotype 2 or 3), and the median baseline log10HCV viral load was 6.1 IU/ml and alanine transaminase 63 U/l. Cirrhosis was present in 36 % (of whom 40 % were decompensated), and 18 % were HCV treatment-experienced. Overall, SVR 12 was achieved in 97 % (99 % genotype 1, 100 % genotype 2, 84 % genotype 3). Five of six (83 %) patients who relapsed had decompensated cirrhosis, and 67 % were also non-adherent to therapy. On-treatment virologic response did not impact SVR.
  
  
  
  High rates of sustained virologic response can be achieved in safety-net HCV-infected patients. Access to DAA-based regimens is critical to addressing HCV-related health disparity in this at-risk population.
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, NH 3-D, San Francisco, CA, 94110, USA.
authors.forename: Kendall R
authors.initials: KR
authors.lastname: Beck
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, NH 3-D, San Francisco, CA, 94110, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, NH 3-D, San Francisco, CA, 94110, USA. Mandana.Khalili@ucsf.edu.|Liver Center, University of California San Francisco, San Francisco, CA, USA. Mandana.Khalili@ucsf.edu.
authors.forename: Mandana
authors.initials: M
authors.lastname: Khalili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D002219:Carbamates; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011759:Pyrrolidines; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D012495:San Francisco; D000069616:Simeprevir / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000627:therapeutic use*; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D001562:Benzimidazoles; D002219:Carbamates; D005449:Fluorenes; D007093:Imidazoles; D011759:Pyrrolidines; C586541:ledipasvir; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons; D000069616:Simeprevir; D014633:Valine; C549273:daclatasvir; D000069474:Sofosbuvir
keywords: Cirrhosis; Direct-acting antiviral therapy; HCV; Sustained virologic response; Underserved population