Adherence in Hepatitis C Virus Treatment: What We Know

Area of Science:

• Hepatology
• Infectious Diseases
• Pharmacology

Background:

• Direct-acting antiviral (DAA) agents offer high cure rates for hepatitis C virus (HCV).
• Concerns about nonadherence, particularly in populations like people who inject drugs (PWID), often lead to denial of DAA therapy.
• The relationship between DAA adherence and efficacy across diverse patient groups is not well-defined.

Purpose of the Study:

• To evaluate the relationship between adherence to DAA therapy and treatment efficacy in various patient populations with HCV.
• To discuss the challenges in standardizing adherence assessment methods for HCV therapy.
• To explore the effectiveness of DAAs in special populations, such as PWID, despite adherence variations.

Main Methods:

• Review of existing data on DAA adherence and sustained virologic response (SVR) in different HCV patient populations.
• Analysis of traditional and technology-based methods for assessing medication adherence.
• Discussion of specific DAA regimens (e.g., sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) and their forgiveness of missed doses.

Main Results:

• DAA therapy demonstrates high efficacy and forgiveness of missed doses across various patient groups.
• Special populations, including PWID, can achieve high rates of sustained virologic response (SVR) with DAA treatment.
• Traditional adherence assessment methods may overestimate adherence, while technology-based methods offer improved accuracy.

Conclusions:

• Antiviral therapy for HCV should not be withheld due to fears of nonadherence.
• High SVR rates are achievable in patients with HCV, including PWID, even with suboptimal adherence.
• Improved adherence assessment and intervention strategies can further enhance SVR rates in HCV treatment.