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Homeless patients with HCV achieved SVR in dedicated care program

Community-based treatment with a dedicated primary care program led to sustained virologic response in most homeless and marginally housed patients with hepatitis C enrolled in a recent study.

“Historically, homeless and marginally housed adults have faced barriers to HCV treatment,” the researchers wrote. “New, interferon-free therapies have excellent cure rates and improved tolerability, reducing barriers for treatment.”

A dedicated HCV treatment team of primary care clinicians and physicians at the Boston Health Care for the Homeless Program treated 64 patients with oral antiviral agents between February 2014 and 2015. Either Medicare or Medicaid covered treatment for all but one patient.

Sixty-two patients achieved SVR. Mean age of these patients was 55.5 years, 77% were men and 47% were white. Overall, 49 patients had genotype 1, three patients had genotype 2, three patients had genotype 4 and seven patients had mixed genotypes.

Of the two patients who did not achieve SVR, one was diagnosed with genotype 2 with cirrhosis, treatment naive, HCV-monoinfected, treated with Sovaldi (sofosbuvir, Gilead) plus ribavirin for 12 weeks, and reported no missed doses. While this patient had an undetectable viral load at the end of treatment, there was detectable viral load at 12 weeks follow-up.

The second patient was diagnosed with genotype 1 with cirrhosis, treatment naive, HCV-monoinfected, treated with Harvoni (ledipasvir-sofosbuvir, Gilead) for 12 weeks, and missed one dose. The patient had a detectable viral load at end of treatment. Resistance testing demonstrated H58P and L31V mutations.

“These findings demonstrate that with a dedicated program for treating HCV in [homeless and marginally housed] adults in the primary care setting, it is possible to achieve outcomes similar to those of clinical trials and other cohorts despite significant additional barriers and competing priorities to health care faced by this population,” the researchers concluded. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.