Academic journal article The Qualitative Report

Patient Perspectives on Adherence to the New Hepatitis C Antiviral Medications: "A New Lease on Life"

Academic journal article The Qualitative Report

Patient Perspectives on Adherence to the New Hepatitis C Antiviral Medications: "A New Lease on Life"

Article excerpt

Hepatitis C virus (HCV) is a widely recognized public health concern in the United States (Centers for Disease Control and Prevention [CDC], 1998; Edlin et al., 2001; Evon et al., 2013; Lawitz et al., 2013; Ly et al., 2012; Moyer, 2013; Sloan, Straits-Troster, Dominitz, & Kivlahan, 2004; Veterans Health Administration, 2015). It is the most common chronic blood borne infection in this country (Alter, 1999; CDC, 2011), particularly in the Veteran population. Globally, about 185 million individuals are infected with HCV, which is a seroprevalence rate of HCV of 2.8% (Hanafiah, Groeger, Flaxman, & Wiersma, 2013). While in the general US population, prevalence of HCV is estimated at 1.8% (CDC, 1998), the prevalence among Veterans enrolled in the Veterans Healthcare Administration (VHA) is much higher, ranging between 8% - 10% (CDC, 1998; Lawitz et al., 2013; Ly et al., 2012; Sloan et al., 2004; Slomski, 2014). VHA is the largest HCV care provider in the United States, serving between 174,000 and 180,000 Veterans between 2009 and 2013 (Veterans Health Administration, 2015). The consequences of chronic HCV infection are well known and mainly consist of cirrhosis and hepatocellular carcinoma that lead to increased healthcare costs and an increased mortality. Projected medical costs for treating HCV between 2010 and 2019 could reach $10.7 billion in direct care and a $54.2 billion societally (Wong, McQuillan, McHutchison, & Poynard, 2000). HCV has now surpassed human immunodeficiency virus as a leading cause of death in the United States (Rustgi, 2007).

New Direct-Acting Antivirals for HCV

New US Food and Drug Administration (FDA) approved direct-acting antivirals (DAAs) (specifically, sofosbuvir, simeprevir, the combination ledipasvir/sofosbuvir, and the combination ombitasvir/paritraprevir/ritonavir and dasabuvir) became available to patients in 2014 at a cost between $66,000 and $84,000 per person for a 12-week course (Brennan & Shrank, 2014; Lawitz et al., 2013; Reau & Jensen, 2014; Slomski, 2014; Steinbrook & Redberg, 2014; Veterans Health Administration, 2015). Some patients who have cirrhosis need a 24-week course of these medications (American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, 2015; Veterans Health Administration, 2015). Compared to traditional interferon-based treatment regimens for Hepatitis C (HCV), these new medications have many benefits. One such benefit is that the new medications to treat HCV have a much lower side effect profile (e.g., less nausea/vomiting, dizziness, depression, sleep problems, skin reactions, headaches, fatigue, flu-like symptoms). Another advantage to taking the new medications is the reduced treatment length and better cure rates (8-24 weeks with a cure rate of 80% to over 90% instead of about 48 weeks with a 45-75% cure rate with interferon-based regimens, depending on a person's genotype [Brennan & Shrank, 2014; Lawitz et al., 2013; Reau & Jensen, 2014; Steinbrook & Redberg, 2014]). Lastly, the noninterferon based treatments are all oral (pills) administration instead of subcutaneous self-injections combined with orally administered medications. The medication prescribed and lengths of treatment are dependent on a thorough assessment of the person's HCV history (e.g., genotype, whether they have cirrhosis, prior HCV treatment, hepatocellular carcinoma [HCC], HIV co-infection). Patients are considered "cured" when the virus is undetectable in their blood three months after treatment completion.

Guidelines for Treatment

The Veterans Health Administration (VHA) has established treatment guidelines for the new HCV medications (Veterans Health Administration, 2015), that require a thorough pre-treatment assessment to identify mainly the patient's HCV genotype, viral load, stage of liver disease (presence or absence of advanced fibrosis/cirrhosis), presence of hepatocellular carcinoma, HIV co-infection, details of past HCV treatment, and mental health and substance abuse issues or cognitive limitations that could affect treatment adherence. …

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