Hepatitis C virus infection characteristics and treatment outcomes in Canadian immigrants
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RESEARCH ARTICLE
Open Access
Hepatitis C virus infection characteristics and treatment outcomes in Canadian immigrants Curtis L. Cooper1,2* , Daniel Read1, Marie-Louise Vachon3, Brian Conway4, Alexander Wong5, Alnoor Ramji6, Sergio Borgia7, Ed Tam8, Lisa Barrett9, Dan Smyth9, Jordan J. Feld10, Sam Lee11 and on behalf of the CANUHC Cohort
Abstract Background: There are multiple obstacles encountered by immigrants attempting to engage hepatitis C virus (HCV) care and treatment. We evaluated the diversity and treatment outcomes of HCV-infected immigrants evaluated for Direct Acting Antiviral (DAA) therapy in Canada. Methods: The Canadian Network Undertaking against Hepatitis C (CANUHC) Cohort contains demographic information and DAA treatment information prospectively collected at 10 Canadian sites. Information on country of origin and race are collected. Characteristics and outcomes (sustained virological response; SVR) were compared by immigration status and race. Results: Between January 2016 and May 2018, 725 HCV-infected patients assessed for DAA therapy were enrolled in CANUHC (mean age: 52.66 ± 12.68 years); 65.66% male; 82.08% White, 5.28% Indigenous, 4.64% South East Asian, 4.64% East Indian, 3.36% Black). 18.48% were born outside of Canada. Mean age was similar [immigrants: 54.36 ± 13.95 years), Canadian-born: 52.27 ± 12.35 years); (p = 0.085)]. The overall baseline fibrosis score (in kPa measured by transient elastography) was similar among Canadian and foreign-born patients. Fibrosis score was not predicted by race or genotype. The proportion initiating DAA therapy was similar by immigrant status (56.72% vs 49.92%). SVR rates by intent-to-treat analysis were similar (immigrants-89.47%, Canadian-born-92.52%; p = 0.575). Conclusion: A diverse immigrant population is engaging care in Canada, initiating HCV antiviral therapy in an equitable fashion and achieving SVR proportions similar to Canada-born patients. Our Canadian experience may be of value in informing HCV elimination efforts in economically developed regions. Keywords: Hepatitis C, Emigrants and immigrants, Antiviral drugs, Sustained Virological response
Background Hepatitis C Virus (HCV) afflicts around 71 million individuals worldwide and is responsible for an estimated 399,000 deaths per year [1]. Direct-acting antivirals * Correspondence: [email protected] 1 University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada 2 University of Ottawa, The Ottawa Hospital-General Campus, G12-501 Smyth Rd, Ottawa, ON K1H 8L6, Canada Full list of author information is available at the end of the article
(DAAs) consist of a short-duration, well tolerated oral drug regime which has proven to be a breakthrough in HCV treatment leading to sustained virologic response (SVR) rates of over 90% in patients with all viral genotypes [2]. Despite the ability of DAAs to reliably cure chronic infection, HCV remains wide-spread and underdiagnosed in Canada [3, 4]. Thus, HCV remains a serious threat to health and well-being with 32,500
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