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. 2019 Jun 24;14(6):e0218706.
doi: 10.1371/journal.pone.0218706. eCollection 2019.

Impact of geographic origin on access to therapy and therapy outcomes in the Swiss Hepatitis C Cohort Study

Matteo Brezzi  1 , Barbara Bertisch  1 , Maroussia Roelens  1 , Darius Moradpour  2 , Benedetta Terziroli Beretta-Piccoli  3 , Nasser Semmo  4 , Beat Müllhaupt  5 , David Semela  6 , Francesco Negro  7 , Olivia Keiser  1 ; Swiss Hepatitis C Cohort Study
Affiliations

Impact of geographic origin on access to therapy and therapy outcomes in the Swiss Hepatitis C Cohort Study

Matteo Brezzi et al. PLoS One. .

Abstract

Late diagnosis and treatment may increase morbidity and mortality among persons with hepatitis C virus (HCV) infection. We included all participants of the Swiss Hepatitis C Cohort Study (SCCS). We used unadjusted and adjusted logistic and Cox regressions to determine the association between the geographic origin of the participants and the following outcomes: antiviral treatment status; sustained virologic response; cirrhosis at enrolment; incident cirrhosis; loss to follow-up (LTFU); and mortality. The analyses were adjusted for sex, baseline age, education, source of income, alcohol consumption, injection drug use (IDU), HCV genotype, HIV or HBV coinfection, duration of HCV infection, time since enrolment, cirrhosis, (type of) HCV treatment, and centre at enrolment. Among 5,356 persons, 1,752 (32.7%) were foreign-born. IDU was more common among Swiss- (64.1%) than foreign-born (36.6%) persons. Cirrhosis at enrolment was more frequent among foreign- than Swiss-born persons, reflecting the high frequency of cirrhosis among Italian-born persons who acquired HCV between 1950 and 1970 in Italian healthcare settings. Although antiviral treatment coverage was similar, the sustained viral response rate was increased and the mortality was lower among foreign-vs. Swiss-born persons, with the lowest mortality in persons from Asia/Oceania. LTFU was more frequent in persons from Germany, Eastern and Southern Europe, and the Americas. In conclusion, in Switzerland, a country with universal healthcare, geographic origin had no influence on hepatitis C treatment access, and the better treatment outcomes among foreign-born persons were likely explained by their lower prevalence of IDU and alcohol consumption than among Swiss-born persons.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: Barbara Bertisch has received travel grants from AbbVie, Gilead and ViiV and has received unrestricted research grants from Gilead. Beat Müllhaupt has served as an advisory board member for AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Janssen-Cilag, MSD, Roche; as a consultant for AbbVie and Gilead; and has received research grants from Gilead and Roche. Francesco Negro has served as advisor for AbbVie, Bristol Myers Squibb, Gilead and MSD and has received unrestricted research grants from Gilead and AbbVie. Nasser Semmo has served as an advisory board member for Gilead and MSD and has received speaker`s fees from AbbVie. Olivia Keiser is funded by a professorship grant (no 163878) from the Swiss National Science Foundation. Matteo Brezzi, Benedetta Terziroli Beretta-Piccoli, David Semela and Darius Moradpour have declared no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Selection of the Swiss Hepatitis C Cohort Study participants included in the unadjusted and adjusted analyses.
Fig 2
Fig 2. Comparison of Swiss- and foreign-born persons for all analyses.
Unadjusted (left) and adjusted (right) logistic and Cox regression analyses for different outcomes of Swiss-born persons (= reference) and foreign-born persons in the Swiss Hepatitis C Cohort Study. Odds ratios (OR; with 95% confidence intervals) are shown for antiviral treatment status (ATS), sustained virologic response (SVR) and cirrhosis at enrolment (CAE). Hazard ratios (HR) are shown for incident cirrhosis (IC), loss to follow-up (LTFU), mortality and attrition.
Fig 3
Fig 3. Comparison of persons by geographic origin: cirrhosis and treatment (outcomes).
Unadjusted and adjusted logistic and Cox regression analyses by geographic origin of the Swiss Hepatitis C Cohort Study participants. The following outcomes are shown: cirrhosis at enrolment (A), incident cirrhosis (B), antiviral treatment status (C), and sustained virologic response (SVR) (D). Odds ratios, hazard ratios and 95% confidence intervals are presented. Missing HIV and HBV values were assumed to be negative.
Fig 4
Fig 4. Comparison of persons by geographic origin: mortality, loss to follow-up and attrition.
Unadjusted and adjusted Cox regression analyses by geographic origin of the Swiss Hepatitis C Cohort Study participants. The following outcomes are shown: mortality (A), loss to follow-up (B) and attrition (C). Hazard ratios and 95% confidence intervals are presented. Missing HIV and HBV values were assumed to be negative.
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