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1. The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals.

Author

Lisa Townshend-Bulson, Elena Roik, Youssef Barbour, Dana J T Bruden, Chriss E Homan, Hannah G F Espera, Timothy J Stevenson, Annette M Hewitt, Wileina Rhodes, James E Gove, Julia N Plotnik, Mary M Snowball, John McGilvray, Brenna C Simons, Janet M Johnston, and Brian J McMahon

Subjects
Medicine, Science
Abstract

BackgroundDirect-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir- based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people.MethodsAN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir.ResultsWe included 501 patients with a mean age of 54.3 (range 21.3-78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria.ConclusionsIn the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status.

Published
2021
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2. Infection With Hepatitis C Virus Genotype 3 is an Independent Risk Factor for End-stage Liver Disease, Hepatocellular Carcinoma, and Liver-related Death

Author

Annette Hewitt, Julia Plotnik, Dana Bruden, Susan Negus, Prabhu Gounder, Brenna C. Simons, Stephen Livingston, Brian J. McMahon, P R Spradling, Lisa Townshend-Bulson, James E. Gove, Chriss Homan, Mary Snowball, Youssef Barbour, Michael G. Bruce, and Hannah Espera

Subjects
Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Genotype, Population, Hepacivirus, Gastroenterology, Article, End Stage Liver Disease, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Prospective Studies, Risk factor, Prospective cohort study, education, Survival analysis, education.field_of_study, Hepatology, business.industry, Hazard ratio, Hepatitis C, Chronic, Middle Aged, medicine.disease, Alaskan Natives, Survival Analysis, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Immunology, Disease Progression, Indians, North American, 030211 gastroenterology & hepatology, Female, business, Alaska, Cohort study
Abstract

Background & Aims Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection. Methods We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012. We calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for end-stage liver disease (ESLD; presence of ascites, esophageal varices, hepatic encephalopathy, or coagulopathy), hepatocellular carcinoma (HCC), and liver-related death using a Cox proportional hazards model. Results We enrolled 1080 participants followed up for 11,171 person-years (mean, 10.3 person-years); 66%, 19%, and 14% were infected with HCV genotypes 1, 2, and 3, respectively. On multivariate analysis, persons infected with HCV genotype 3 had a significantly increased risk of developing all 3 adverse outcomes. Their aHR for ESLD was 2.1 (95% CI, 1.5–3.0), their aHR for HCC was 3.1 (95% CI, 1.4–6.6), and their aHR for liver-related death was 2.4 (95% CI, 1.5–4.0) compared with genotype 1. Heavy alcohol use was an age-adjusted risk factor for ESLD (aHR, 2.2; 95% CI, 1.6–3.2), and liver-related death (aHR, 2.9; 95% CI, 1.8–4.6). Obesity was a risk factor for ESLD (aHR, 1.4; 95% CI, 1.0–1.9), and diabetes was a risk factor for ESLD (aHR, 1.5; 95% CI, 1.1–2.2). Male sex was a risk factor for HCC (aHR, 3.6; 95% CI, 1.6–8.2). Conclusions In a population-based cohort study of American Indian/Alaska Native persons with chronic HCV infection, we found those infected with HCV genotype 3 to be at high risk for ESLD, HCC, and liver-related death.

Published
2016

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