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Short article: Alcohol and substance use, race, and insurance status predict nontreatment for hepatitis C virus in the era of direct acting antivirals a retrospective study in a large urban tertiary center

Sims, Omar T.a,b; Guo, Yuqie; Shoreibah, Mohamed G.c; Venkata, Krishnad; Fitzmorris, Paulc; Kommineni, Vishnud; Romano, Johnd; Massoud, Omar I.c

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1219–1222
doi: 10.1097/MEG.0000000000000961
Original Articles: Hepatitis

Objective Direct acting antivirals (DAAs) have overcome many long-standing medical barriers to hepatitis C virus (HCV) treatment (i.e. host characteristics and medical contraindications) and treatment outcome disparities that were associated with interferon regimens. The public health and clinical benefit of current and forthcoming DAA discoveries will be limited if efforts are not made to examine racial, psychological, and socioeconomic factors associated with being treated with DAAs. This study examined racial, psychological, and socioeconomic factors that facilitate and inhibit patients receiving DAAs for HCV.

Patients and methods This was a single-center retrospective cohort study at a large urban tertiary center of patients (n=747) who were referred for evaluation and treatment of HCV.

Results Sixty-eight percent of patients were non-Hispanic White, 31% were African American, and 1% were of other ethnicities. The majority of patients received treatment, but 29% (218/747) did not. Patients who were older [odds ratio (OR)=1.02, 95% confidence interval (CI): 1.01–1.04] and insured (OR=2.73, 95% CI: 1.12–6.97) were more likely to receive HCV treatment. Patients who were African American (OR=0.46, 95% CI: 0.46–1.06), used drugs (OR=0.09, 95% CI: 0.04–0.17), smoked (OR=0.55, 95% CI: 0.37–0.81), and used alcohol (OR=0.11, 95% CI: 0.06–0.20) were less likely to receive HCV treatment.

Conclusion Though DAAs have eliminated many historically, long-standing medical barriers to HCV treatment, several racial, psychological and socioeconomic barriers, and disparities remain. Consequently, patients who are African American, uninsured, and actively use drugs and alcohol will suffer from increased HCV-related morbidity and mortality in the coming years if deliberate public health and clinical efforts are not made to facilitate access to DAAs.

aDepartment of Social Work, College of Arts and Sciences

bDepartment of Health Behavior, School of Public Health, Center for AIDS Research

cDivision of Gastroenterology & Hepatology

dDepartment of Internal Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham

eSchool of Social Work, University of Alabama, Tuscaloosa, Alabama, USA

Correspondence to Omar T. Sims, PhD, Department of Social Work, College of Arts and Sciences, School of Medicine, University of Alabama at Birmingham, HB 301C, 1720 2nd Ave S, Birmingham, AL 35294-1260, USA Tel: +1 205 975 4938; fax: +1 205 975 6639; e-mail:

Received May 2, 2017

Accepted July 24, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.