Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Pharmacy, Infection Control
Hepatitis C, Chronic, Ambulatory Care Facilities
PURPOSE/BACKGROUND: Chronic hepatitis C is a significant public health threat in the United States, with an estimated 2.4 million people infected with hepatitis C virus (HCV).1 Maine reported 439 new cases of confirmed chronic hepatitis C in 2017.2 The Gilman clinic (formerly Virology Treatment Center) is affiliated with Maine Medical Center and provides care for chronic viral hepatitis to a large patient population, who are frequently underserved. In the last 5 years, the clinic has seen an average of 253 new chronic hepatitis C patients per year; for 2017, this represented more than half of the total newly confirmed chronic HCV cases in Maine. We sought to analyze Gilman clinic’s treatment and cure rates for chronic hepatitis C, as well as overall compliance with American Association for the Study of Liver Disease and the Infectious Diseases Society of America guidelines for HCV management.
METHODS/APPROACH: A retrospective chart review was performed, to include all the adult Gilman clinic patients (n=109) who had an initial consult for chronic hepatitis C, from July to December 2018. Data were analyzed descriptively as frequencies and percentages.
RESULTS: Patients were primarily male (65%) and White non-Hispanic (95%), with a median age of 49. Most had current or prior illicit drug use history (85%), and 16.5% described unhealthy alcohol use at the time of their initial consult. HCV treatment with direct-acting antivirals was recommended in 94% of the patients who continued to follow up at the clinic after their initial consult (89 out of 95 patients). Treatment was initiated in 79% of these cases (70 out of 89 patients), at a median interval of 2.6 months from the initial visit; the most common reasons for non-initiation of treatment were patients’ lack of follow-up at the clinic or transfer of care. The SVR12 test (sustained virologic response at 12 weeks post-treatment) was completed in 75.5% of treated patients, with a cure rate of 96%. Notably, the SVR12 completion rate was 91% in patients who had an SVR12 visit, compared to 62% in patients who did not.
CONCLUSIONS: HCV cure rates are high regardless of patients’ history of substance use disorder. Active or past illicit drug use, or unhealthy alcohol use, should not constitute barriers to HCV treatment. Scheduling SVR12 visits will likely increase SVR12 completion rates.
REFERENCES: 1. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013?2016. Hepatology. 2019;69(3):1020-1031. https://onlinelibrary.wiley.com/doi/abs/10.1002/hep.30297. doi: 10.1002/hep.30297. 2. Hepatitis C Tables and Figures. The Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/statistics/2017surveillance/TablesFigures-HepC.htm#tabs-1-3. Reviewed November 13, 2019. Accessed February 26, 2020.
Toma, Nicoleta; Garrett, Katy; and Thakarar, Kinna, "An analysis of chronic hepatitis C management and cure rates at the Gilman Clinic in Portland, ME, from July to December 2018" (2020). Costas T. Lambrew Research Retreat 2020. 113.