Department of Infectious Diseases and Allergology, Jan Kochanowski University, Kielce, 25-317, Poland.
Collegium Medicum, Jan Kochanowski University, aleja IX Wieków Kielc 19A, Kielce, 25-317, Poland.
BMC Med. 2024 Oct 23;22(1):486. doi: 10.1186/s12916-024-03699-z.
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.
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.
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.
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.
消除丙型肝炎病毒（HCV）感染是世界卫生组织设定的目标。随着高效、安全的直接作用抗病毒药物（DAA）的引入，这一目标已经成为可能，但由于未确诊的 HCV 感染以及在各个阶段的护理链中患者的流失，包括在评估治疗效果之前失去随访（LTFU）的患者，这一目标仍然存在。我们研究的目的是确定这种流失的程度，并确定经历这种流失的患者的特征。
本研究纳入了来自波兰回顾性多中心 EpiTer-2 数据库的接受 DAA 治疗的慢性 HCV 感染患者，这些患者的治疗时间在 2015 年至 2023 年之间。
在 18968 例患者的研究人群中，有 106 例患者在治疗后 12 周的随访期结束时死亡，有 509 例患者在存活期间未报告评估治疗效果，被视为 LTFU。在有持续病毒学应答（SVR）评估的患者中，治疗的有效性为 97.5%。与有 SVR 评估的患者相比，LTFU 患者中男性（p<0.0001）的比例显著更高，中位年龄更低（p=0.0001）。在 LTFU 患者中，酒精（p<0.0001）和药物成瘾（p=0.0005）、抑郁（p=0.0449）或其他精神障碍（p<0.0001）、以及人类免疫缺陷病毒（HIV）合并感染（p<0.0001）等合并症的比例显著更高。与有 SVR 评估的患者相比，他们也更有可能感染基因型（GT）3，不太可能接受过抗病毒治疗，更有可能停止 DAA 治疗。
在近 19000 例 HCV 感染患者的真实世界人群中，我们记录了 2.7%的失访率。这种现象的独立预测因素是男性、GT3 感染、HIV 合并感染、酒精成瘾、精神疾病、缺乏既往抗病毒治疗和 DAA 治疗中断。
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