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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2019/01  
 
  2019 Jan;69(1):51-63.  
  doi: 10.1002/hep.30171.  
 
  Has Access to Hepatitis C Virus Therapy Changed for Patients With Mental Health or Substance Use Disorders in the Direct-Acting-Antiviral Period?  
 
  Jain MK, Thamer M, Therapondos G, Shiffman ML, Kshirsagar O, Clark C, Wong RJ  
  https://www.ncbi.nlm.nih.gov/pubmed/30019478  
 
 

Abstract

Direct-acting antivirals (DAA) for hepatitis C virus (HCV) became available in 2014, but the role of mental health or substance use disorders (MH/SUD) on access to treatment is unknown. The objective of this study was to examine the extent and predictors of HCV treatment in the pre-DAA and post-DAA periods in four large, diverse health care settings in the United States. We conducted a retrospective analysis of 29,544 adults with chronic HCV who did or did not receive treatment from January 1, 2011, to February 28, 2017. Kaplan-Meier curve was used to examine cumulative risk for receiving HCV treatment stratified by MH/SUD. Predictors of HCV treatment in the pre-DAA (January 1, 2011, to December 31, 2013) and post-DAA (January 1, 2014, to February 28, 2017) cohorts were analyzed using multivariate generalized estimating equations and a modified Poisson model. Overall, 21.7% (2,879/13,240) of those with chronic HCV post-DAA were treated compared with 3.5% (574/16,304) in the pre-DAA period. Compared with non-Hispanic whites, Hispanic whites (adjusted odds ratio [AOR] 0.36; 95% confidence interval [CI], 0.25, 0.52) were less likely to be treated in the post-DAA period. Those with concurrent nonalcoholic fatty liver disease (AOR 1.39; 95% CI, 1.05, 1.83), cirrhosis (AOR 2.00; 95% CI, 1.74, 2.31), and liver transplant (AOR 2.72; 95% CI, 1.87, 3.94) were more likely to be treated post-DAA. Those with MH/SUD were less likely to be treated both before (AOR 0.46; 95% CI, 0.36, 0.60) and after (AOR 0.63; 95% CI, 0.55, 0.71) DAA therapy was available. Overall, the cumulative risk for receiving HCV treatment from 2011 to 2017 among those with versus without MH/SUD was 13.6% versus 21.6%, respectively (P < 0.001).

Conclusion: The volume of patients treated for HCV has increased in the post-DAA period, especially among those with liver-related comorbidities, but disparities in access to treatment continue among those with MH/SUD.

 

 
Question posée
 
Rôle de la santé mentale ou de maladie associée à l’usage de drogue sur le traitement de l’hépatite chronique virale C avant et après l’arrivée des anti-viraux directs (DAA) aux USA à partir d’une étude rétrospective de 29544 adultes.
 
Question posée
 
Globalement, 22% des patients VHC ont été traités post-DAA comparés à 3,5% en pré-DAA. Les patients hispaniques blancs ont été moins traités en post-DAA alors que les patients avec une NAFLD associée, une cirrhose et en pré-transplantation ont été plus traités. Les patients avec maladie mentale ou usage de drogues ont été aussi moins traités avant et après DAA.
 
Commentaires

Même si les DAA ont permis de traiter plus de patients, il existe encore des disparités de prise en charge aux USA et sont surtout impactés les patients VHC avec maladie mentale ou usage de drogues. Qu’en est-il en France ?

 
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