Lack of follow-up ‘should have minimal effect’ on HCV elimination

Patients with hepatitis C who had regular follow-up and those who had delayed follow-up after treatment with direct-acting antiviral agents achieved similar sustained virologic response, according to study results presented at The Liver Meeting Digital Experience.

“Recent advances in HCV treatment using direct-acting antivirals can lead to SVR in almost all patients. Furthermore, generic DAAs have become available at a reduced cost and have enhanced the potential for treatment access worldwide. This has led to the WHO ENDHEP 2030 goals,” Sita Kottilil, from the NIH and Walter Johnson High School in Bethesda, Maryland, said during a virtual poster presentation. “However, recent elimination demonstration projects have failed to meet the high SVR standards due to lack of follow-up from patients after treatment.”

For their study, Kottilil and colleagues sought to determined SVR among patients with on-time follow-up compared with those with delayed follow-up.

The study, conducted at a subspecialty hepatitis clinic in Mumbai, India between 2015 and 2018, included 226 patients with chronic HCV who underwent treatment using a DAA regimen. Patients who attended a follow-up visit for determination of SVR within a month of their 12-week posttreatment visit were deemed to have regular follow-up. Patients with delayed follow-up included those who came for a follow-up visit for SVR determination after 16 weeks posttreatment.

Of all patients, 131 had regular follow-up, 89 had delayed follow-up and six were completely lost to follow-up and were therefore excluded from the analysis. Both patients with regular follow-up and patients with delayed follow-up were similar with respect to comorbidities, except for cirrhosis, which was more prevalent in the delayed follow-up arm. There were also no differences in baseline HCV RNA or baseline ALT levels, according to Kottilil.

Overall, the SVR, or test of cure, was 96.9% for patients with regular follow-up and 97.8% for patients with delayed follow-up — the difference of which was not statistically significant. Additionally, all patients tolerated DAA treatment without any serious adverse events.

The researchers obtained no clear reason for lack of follow-up.

Overall, these findings suggest that lack of follow-up after completion of treatment “should have minimal effect” on HCV elimination projects and that these projects need not focus on determination of SVR posttreatment as long as on-treatment follow-up is ensured, according Kottilil.

“In other words, a test of cure is not necessary,” Kottilil said.