This analysis reviewed 3,537 people treated for chronic hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) between 2016 and 2021. Among these patients, 652 were classified as migrants and the remainder were Australian-born. The investigators described differences in clinical and demographic characteristics at enrolment and compared treatment outcomes, liver disease stage, and survival by migrant status.
At study entry, Australian-born patients were younger, with a mean age of 51.5 years versus 54.2 years for migrants (p < 0.001). Australian-born individuals were more likely to report histories of injection drug use (statistically significant), risky alcohol consumption (p < 0.001), and receipt of opioid replacement therapy (p < 0.001). These behavioral differences between groups are noted as potential contributors to HCV exposure risk and may affect engagement with care.
Migrants had higher prevalences of several comorbid conditions. Diabetes was more common in migrants (13.9% vs. 10.3%; p = 0.008). Markers of hepatitis B virus (HBV) exposure were substantially greater among migrants (43.3% vs. 29.7%; p < 0.001), and active HBV infection was also more frequent in migrants (3.1% vs. 1.6%; p = 0.033). The authors report these differences but do not provide further detail about the clinical management of HBV coinfection in the abstract.
HCV genotype distribution differed by migrant status. Genotypes 4, 5, and 6 were more prevalent among migrants (18.3% vs. 6.6%; p < 0.001). The study highlights genotype differences as an important epidemiologic distinction that may reflect region-of-origin patterns and could influence natural history or treatment considerations. The authors specifically report that in migrants, genotype 3 was associated with increased odds of more advanced liver disease (see the fibrosis and cirrhosis section below).
Overall sustained virologic response (SVR) rates after DAA treatment were comparable between migrants and Australian-born patients (p = 0.69). However, when stratified by cirrhosis status, migrants with cirrhosis had lower SVR rates than Australian-born patients with cirrhosis (88.2% vs. 95.2%; p = 0.002). The abstract does not specify potential explanations for this subgroup difference, nor does it report regimen-specific SVR results or adherence details.
Prevalence of advanced liver disease was reported as follows across the cohort: advanced fibrosis occurred in 24.5% and cirrhosis in 35.0% of patients. These proportions did not differ significantly by migrant status (all p > 0.05). In multivariable models among migrants, HCV genotype 3 was associated with higher odds of advanced fibrosis (adjusted odds ratio [adj-OR] = 1.70, 95% CI 1.40–2.06) and cirrhosis (adj-OR = 1.74, 95% CI 1.48–2.04; p < 0.001). Genotypes 2, 4, and 6 were not associated with fibrosis or cirrhosis in adjusted analyses (all p > 0.05).
Five-year survival did not differ overall by migrant status (p > 0.05). Kaplan–Meier analyses and adjusted Cox regression examined all-cause survival from the time of HCV treatment initiation according to migrant status and region of birth. The abstract reports adjusted hazard ratios (aHRs) for specific regions compared to Australian-born patients: New Zealand & Oceania had an aHR of 0.67 (95% CI 0.25–1.81; p = 0.43), Europe & Americas an aHR of 1.11 (95% CI 0.74–1.66; p = 0.62), and Asia, Africa & Middle East an aHR of 0.54 (95% CI 0.30–0.96; p = 0.037). The aHR for Asia/Africa/Middle East indicates a statistically lower adjusted hazard of all-cause mortality in that grouped region relative to Australian-born patients.
The authors used multivariable logistic regression to examine associations with advanced fibrosis and cirrhosis, and Cox proportional hazards regression for survival analyses. Reported measures include means, proportions, p values, adjusted odds ratios with 95% confidence intervals for fibrosis/cirrhosis outcomes, and adjusted hazard ratios with 95% confidence intervals for survival comparisons by region of birth. The abstract notes p values for key comparisons and specifies which associations reached statistical significance.
In this cohort of DAA-treated patients, migrants experienced overall equivalent SVR and similar rates of advanced fibrosis and cirrhosis compared with Australian-born patients. However, migrants with cirrhosis had lower SVR rates than Australian-born patients with cirrhosis. Migrants more commonly had diabetes, prior HBV exposure, active HBV infection, and non–genotype 1 HCV (notably genotypes 4–6). Among migrants, HCV genotype 3 was linked to greater odds of advanced fibrosis and cirrhosis. Five-year survival was similar or better in migrants overall, with one region (Asia, Africa & Middle East) showing a lower adjusted hazard of death compared with Australian-born patients.
Limitations and additional methodological details are not reported in the abstract. For full methods, subgroup analyses, regimen-specific SVR data, and management of HBV coinfection, consult the full published article in Journal of Viral Hepatitis.