Article

Direct acting antiviral treatment of chronic hepatitis C in Denmark: factors associated with and barriers to treatment initiation

Scandinavian Journal of Gastroenterology, Taylor & Francis, ISSN 1502-7708

Volume 53, 7, 2018

DOI:10.1080/00365521.2018.1467963, Dimensions: pub.1103765865, PMID: 29720023,

Affiliations

Organisations

  1. (1) Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; ; Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;, http://orcid.org/0000-0001-8149-3780, View further author information
  2. (2) Hvidovre Hospital, grid.411905.8, Capital Region
  3. (3) Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; ; Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark; ; Department of Science and Environment, Roskilde University, Roskilde, Denmark;, View further author information
  4. (4) Roskilde University, grid.11702.35, RUC
  5. (5) Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;, View further author information
  6. (6) Aalborg Hospital, grid.27530.33, North Denmark Region
  7. (7) Sygehus Lillebælt, grid.459623.f, Southern Denmark Region
  8. (8) Odense University Hospital, grid.7143.1, Southern Denmark Region
  9. (9) University of Southern Denmark, grid.10825.3e, SDU
  10. (10) Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark;, View further author information
  11. (11) Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;, View further author information
  12. (12) University of Copenhagen, grid.5254.6, KU
  13. (13) Department of Gastroenterology, Copenhagen University Hospital, Herlev, Denmark;, View further author information
  14. (14) Zealand University Hospital, grid.476266.7, Zealand Region
  15. (15) Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark; ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;, View further author information
  16. (16) Technical University of Denmark, grid.5170.3, DTU
  17. (17) Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; ; Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;, View further author information

Countries

Denmark

Continents

Europe

Description

OBJECTIVES: We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark. MATERIALS AND METHODS: In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause. RESULTS: In 344 (49%) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38-3.28), previous treatment failure OR 2.58 (CI: 1.84-3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18-2.17). The most frequent reasons for not starting treatment among 356 (51%) patients were non-adherence to medical appointments (n = 107/30%) and ongoing substance use (n = 61/17%). Treatment failure with viral relapse occurred in 19 (5.5%) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59-12.91). CONCLUSIONS: In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.

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Links & Metrics

NORA University Profiles

Roskilde University

University of Southern Denmark

University of Copenhagen

Technical University of Denmark

Danish Open Access Indicator

2018: Unused

Research area: Medicine

Danish Bibliometrics Indicator

2018: Level 1

Research area: Medicine

Dimensions Citation Indicators

Times Cited: 4

Field Citation Ratio (FCR): 2.52

Relative Citation ratio (RCR): 0.38