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EXTREMELY LOW UPTAKE OF HEPATITIS C VIRUS (HCV) INFECTION TREATMENT IN A COMMUNITY-BASED STUDY OF INNER CITY RESIDENTS IN VANCOUVER
J Grebely1, JD Raffa2, C Lai3, M Krajden4, B Fischer5,6, T Kerr3,7, MW Tyndall3,7
1Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia; 2Department of Statistics and Actuarial Science, University of Waterloo; 3BC Centre for Excellence in HIV/AIDS; 4BC Centre for Disease Control, Vancouver, British Columbia; 5Centre for Addictions Research BC, University of Victoria; 6Centre for Addiction and Mental Health, University of Toronto; 7Department of Medicine, University of British Columbia
AIM: In Canada, very few IDUs have received treatment for HCV, despite data demonstrating treatment to be safe and effective in this group. We sought to estimate HCV treatment uptake in a large community-based inner city cohort in Vancouver and compare this to the incidence of HCV infection over the period January 2000 to December 2004.
METHODS: CHASE is a cohort study of inner city residents recruited from January 2003 to June 2004. HIV and HCV status were determined through linkage with provincial databases. Treatment information was derived from the British Columbia Ministry of Health Pharmacare database (January 2000 to December 2004), which contains information on all HCV treatment prescriptions in the province. The incidence of HCV infection and the rate of HCV treatment uptake were calculated, expressed in terms of person-years of observation and compared over the follow-up period.
RESULTS: As of December 2004, among 3,553 subjects enrolled, HCV antibody testing was performed in 2,117 and the HCV seroprevalence was 64.3% (n=1,361). In total, between January 2000 and December 2004, 15 HCV antibody positive subjects initiated HCV treatment (1.1%), accounting for a total of 5420 person-years of follow-up, 0.28 cases per 100 person-years (95% CI, 0.15-0.46). Overall, only 3/15 (0.2%) HCV antibody positive subjects achieved a sustained virologic response following treatment. During the same period, 91 HCV seroconversions were observed (1285 person years of follow-up), yielding an overall incidence of 7.08 cases per 100 person years (95% CI 5.70-8.70).The incidence of HCV among current IDUs was 23.1 cases per 100 person-years (95% CI, 17.5-28.5). Overall, the rate of new HCV seroconversions was ~25 times that of the rate of HCV treatment uptake.
CONCLUSIONS: We have documented low rates of HCV treatment initiation and limited effectiveness of antiviral treatment for HCV, despite a high prevalence and incidence of infection in a large cohort of inner city residents in Vancouver.