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Multicenter Study
. 2024 Oct 23;22(1):486.
doi: 10.1186/s12916-024-03699-z.

Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination

Dorota Zarębska-Michaluk #  1 , Michał Brzdęk #  2 , Olga Tronina  3 , Justyna Janocha-Litwin  4 , Marek Sitko  5 , Anna Piekarska  6 , Jakub Klapaczyński  7 , Anna Parfieniuk-Kowerda  8 , Barbara Sobala-Szczygieł  9 , Magdalena Tudrujek-Zdunek  10 , Łukasz Laurans  11   12 , Robert Flisiak  8
Affiliations
Multicenter Study

Loss to follow-up of patients after antiviral treatment as an additional barrier to HCV elimination

Dorota Zarębska-Michaluk et al. BMC Med. .

Erratum in

Abstract

Background: Eliminating hepatitis C virus (HCV) infections is a goal set by the World Health Organization. This has become possible with the introduction of highly effective and safe direct-acting antivirals (DAA) but limitations remain due to undiagnosed HCV infections and loss of patients from the cascade of care at various stages, including those lost to follow-up (LTFU) before the assessment of the effectiveness of the therapy. The aim of our study was to determine the extent of this loss and to establish the characteristics of patients experiencing it.

Methods: Patients with chronic HCV infection from the Polish retrospective multicenter EpiTer-2 database who were treated with DAA therapies between 2015 and 2023 were included in the study.

Results: In the study population of 18,968 patients, 106 had died by the end of the 12-week post-treatment follow-up period, and 509 patients did not report for evaluation of therapy effectiveness while alive and were considered LTFU. Among patients with available assessment of sustained virological response (SVR), the effectiveness of therapy was 97.5%. A significantly higher percentage of men (p<0.0001) and a lower median age (p=0.0001) were documented in LTFU compared to the group with available SVR assessment. In LTFU patients, comorbidities such as alcohol (p<0.0001) and drug addiction (p=0.0005), depression (p=0.0449) or other mental disorders (p<0.0001), and co-infection with human immunodeficiency virus (HIV) (p<0.0001) were significantly more common as compared to those with SVR assessment. They were also significantly more often infected with genotype (GT) 3, less likely to be treatment-experienced and more likely to discontinue DAA therapy.

Conclusions: In a real-world population of nearly 19,000 HCV-infected patients, we documented a 2.7% loss to follow-up rate. Independent predictors of this phenomenon were male gender, GT3 infection, HIV co-infection, alcohol addiction, mental illnesses, lack of prior antiviral treatment and discontinuation of DAA therapy.

Keywords: Direct-acting antivirals; HCV; Lost to follow-up; Treatment.

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Conflict of interest statement

Zarębska-Michaluk D has acted as a speaker for AbbVie and Gilead, Brzdęk M has no conflict of interest to declare. Tronina O has no conflict of interest to declare. Janocha-Litwin J has no conflict of interest to declare. Sitko M has acted as a speaker for Gilead and AbbVie. Piekarska A has acted as a speaker and/or advisor for AbbVie, Gilead, Merck, and Roche. Klapaczyński J has acted as a speaker for Gilead and AbbVie. Parfieniuk-Kowerda A has no conflict of interest to declare. Barbara Sobala-Szczygieł has been a speaker for AbbVie and Gilead. Tudrujek-Zdunek M has no conflict of interest to declare. Lorenc B has no conflict of interest to declare. Flisiak R has acted as a speaker and/or advisor, and has received funding for clinical research from AbbVie, Gilead, Merck, and Roche.

Figures

Fig. 1
Fig. 1
Study population. Abbreviations: LTFU, loss to follow-up; SVR, sustained virological response
Fig. 2
Fig. 2
The percentage of LTFU in the periods of the EpiTer-2 project. Abbreviations: LTFU, loss to follow-up
Fig. 3
Fig. 3
End-of-treatment response in a population of LTFU and patients with SVR assessment. Abbreviations: HCV, hepatitis C virus; LTFU, loss to follow-up; SVR, sustained virological response
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