Data from: Long-term benefit of hepatitis C therapy in a safety net hospital system: a cross-sectional study with median 5-year follow-up

Objectives: To demonstrate the effectiveness of hepatitis C virus (HCV)
therapy and survival benefit from sustained virologic remission (SVR) in a
safety net hospital population with limited resources. Design and setting:
We conducted a retrospective cross-sectional study at an urban safety-net
hospital in the U.S. Participants and intervention: 242 patients receiving
standard HCV therapy between 2001 and 2006. Primary and secondary outcome
measures: Response rates, including sustained virologic response (SVR),
were recorded for each patient. Univariate and multivariate analyses were
performed to identify predictors of SVR and 5 year survival. Results: A
total of 242 eligible patients were treated. Treatment was completed in
197 (81%) patients, with 43 patients discontinuing therapy early – 32 due
to adverse events and 11 due to non-compliance. Complications on treatment
were frequent, including 3 deaths. SVR was achieved in 83 patients (34%).
On multivariate analysis, independent predictors of a decreased likelihood
of achieving SVR included African American race (OR 0.20, 95% CI 0.07 –
0.54), genotype 1 HCV infection (OR 0.25, 95% CI 0.13 – 0.50) and the
presence of cirrhosis (OR 0.26, 95% CI 0.12 – 0.58). Survival was 98% in
those achieving SVR (median follow-up 72 months) and 71% in non-responders
and those discontinuing therapy (n = 91, median known follow-up 65 and 36
months respectively). On multivariate analysis, the only independent
predictor of improved survival was SVR (HR 0.12, 95% CI 0.03 – 0.52). Both
cirrhosis and hypoalbuminemia were independent predictors of increased
mortality. Conclusions: HCV therapy can be effective despite limited
resources. Survival is improved in those achieving SVR. Treatment before
histologic cirrhosis develops, in combination with careful selection, may
improve long-term outcomes without compromising other health care
endeavors in safety net hospitals and areas with financial limitations.