Outcomes of Hepatitis C Therapy in Patients with Infective Endocarditis
Overview
A retrospective study of 64 patients with infective endocarditis and hepatitis C virus (HCV) infection managed by a collaborative healthcare team showed that 75% initiated antiviral treatment, with 69% completing therapy. Despite coordinated care efforts, sustained virologic response at 12 weeks post-treatment was achieved in only 42% of treated patients, highlighting ongoing challenges in this population.
Background
Patients with infective endocarditis frequently have a history of injection drug use, placing them at high risk for HCV infection. The prevalence of injection drug use and HCV has increased significantly in the United States, yet treatment uptake remains low due to barriers such as stigma, insurance restrictions, and socioeconomic factors. Direct-acting antivirals (DAAs) can cure over 95% of HCV infections, but access and adherence challenges persist, especially in vulnerable populations. Multidisciplinary teams have been proposed to improve treatment initiation and outcomes in these complex patients.
Data Highlights
Parameter
Value
Number of patients with endocarditis and HCV
64
Median age
37 years
Female patients
41%
History of injection drug use
97%
Patients initiating HCV treatment
75% (48/64)
Patients completing treatment
69% (33/48)
Reasons for discontinuation
Loss to follow-up (10), Medication side effects (3)
Sustained virologic response at 12 weeks (SVR12) among treated
42% (20/48)
SVR12 among all patients
31%
HCV RNA negative at 12 weeks posttreatment (lab data available)
91% (20/22)
Key Findings
Among 64 patients with infective endocarditis and HCV, 75% initiated direct-acting antiviral therapy after discharge.
Only 69% of those who started treatment completed the full course.
Loss to follow-up was the primary reason for treatment discontinuation, followed by medication side effects.
Sustained virologic response at 12 weeks post-treatment was achieved in 42% of treated patients and 31% overall.
Among patients with available laboratory data, 91% were HCV RNA negative at 12 weeks post-treatment, indicating viral clearance.
Despite interdisciplinary coordination and expedited treatment pathways, SVR rates remained below 40%, underscoring persistent barriers.
Clinical Implications
Multidisciplinary collaboration between specialty pharmacy and infectious disease teams can facilitate initiation of HCV therapy in patients with infective endocarditis and substance use history. However, high rates of loss to follow-up and suboptimal sustained virologic response highlight the need for enhanced strategies, such as initiating therapy during hospitalization or dispensing the entire medication course at discharge, to improve adherence and outcomes. Clinicians should prioritize integrated care models and address social determinants to optimize HCV treatment success in this vulnerable population.
Conclusion
While coordinated care models improve access to HCV treatment in patients with infective endocarditis, sustained virologic response rates remain low due to adherence challenges and loss to follow-up. Further research is needed to identify interventions that enhance treatment completion and viral cure in this high-risk group.
References
University of Kentucky Study 2024 -- Outcomes of Hepatitis C Therapy in Patients with Infective Endocarditis Managed by a Collaborative Healthcare Team
