Please use this identifier to cite or link to this item: https://dora.health.qld.gov.au/qldresearchjspui/handle/1/1730
Title: Retreatment for hepatitis C virus direct acting antiviral therapy virological failure in primary and tertiary settings: the REACH-C cohort
Authors: Carson, Joanne M
Hajarizadeh, Behzad
Hanson, Josh 
O'Beirne, James 
Iser, David
Read, Phillip
Balcomb, Anne
Davies, Jane
Doyle, Joseph S
Yee, Jasmine
Martinello, Marianne
Marks, Philippa
Matthews, Gail V
Dore, Gregory J
Issue Date: 2022
Publisher: Wiley
Source: Carson JM, Hajarizadeh B, Hanson J, et al. Retreatment for hepatitis C virus direct-acting antiviral therapy virological failure in primary and tertiary settings: The REACH-C cohort. J Viral Hepat. 2022;00:1-16. doi: 10.1111/jvh.13705
Journal: Journal of viral hepatitis
Abstract: Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n=10843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary (n=56) and tertiary (n=157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per-protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p=1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11-0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64-11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15-0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralised models may increase retreatment uptake and reduce HCV-related mortality.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated author: Josh Hanson
DOI: 10.1111/jvh.13705
Keywords: direct-acting antivirals;HCV;primary care;retreatment;virological failure
Type: Article
Appears in Sites:Cairns & Hinterland HHS Publications

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