We evaluated the shift in the characteristics of people who received
interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting
antivirals (DAAs) in British Columbia (BC), Canada. The BC
Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of
hepatitis B and active
tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization,
cancer,
prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older
interferon-based treatments including pegylated
interferon/
ribavirin (PegIFN/RBV) with/without
boceprevir or
telaprevir, DAAs with RBV or PegIFN/RBV, and newer
interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received
interferon-free DAAs (
ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving
interferon-based treatment, people with HIV
co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81),
cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated
cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and
opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive
interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.