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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: More than 23% of adults with HCV infection who initiated DAA therapy had no follow-up test. Improving testing and combining prescription and laboratory data could help monitor HCV elimination progress. Approximately one in four adults with hepatitis C virus infection who initiated treatment with direct-acting antivirals did not undergo follow-up RNA testing, according to a research letter published in JAMA Network Open. However, 90% of that unmonitored population had been prescribed at least 56 days of DAA therapy, potentially leaving cured individuals unaccounted for and highlighting a notable gap in HCV surveillance efforts.
Data derived from\u00a0Symum H, et al. JAMA Netw Open. 2026;doi:10.1001\/jamanetworkopen.2026.21736.
\u201cMeasuring care outcomes is essential to monitoring progress toward hepatitis C elimination,\u201d Hasan Symum, PhD, of the CDC\u2019s division of viral hepatitis, and colleagues wrote. More than 95% of people with HCV who are treated with DAAs achieve sustained virologic response, or cure, with no detectable HCV RNA at least 12 weeks after completing treatment, according to the researchers. Documentation of DAA initiation also has been used to monitor HCV treatment success. To better understand HCV care outcome measures, Symum and colleagues used the HealthVerity database to analyze longitudinal laboratory results, pharmacy claims and insurance enrollment information for more than 4.5 million U.S. adults who underwent at least one HCV antibody, RNA or genotype testing between Jan. 30, 2019, and June 30, 2022. Analysis included 91,491 individuals (53.2% men) who ever had HCV and were insured. Of those, 82,422 individuals (90.1%) received at least one HCV RNA test. Sixty-two percent (n = 51,068) of those tested had initial HCV infection. More than one-third (39.9%) achieved viral clearance, 35.7% initiated treatment and 26.1% had viral clearance after treatment initiation. Of those with initial infection, 38.3% did not undergo follow-up RNA testing. More than three-quarters (78.4%) had no evidence that treatment was initiated. Of the 18,246 individuals who did initiate treatment, 73.2% had a negative follow-up test result, 3.7% had a positive result and 23.2% had no evidence of testing. However, 90.8% of those with no follow-up testing had been prescribed at least 56 days of DAAs and \u201clikely achieved treatment-induced viral clearance,\u201d Symum and colleagues wrote. Of the 32,822 individuals who did not start treatment, 21.3% had a negative follow-up test result, suggesting spontaneous clearance or undocumented treatment, according to the researchers. Nearly one-third (32.1%) had a positive results and 46.7% had no follow-up test. Symum and colleagues acknowledged several study limitations, including the possibility that insurance claims were not filed for treatment, potential misclassification of infection status or outcomes, and exclusion of individuals with unstable insurance coverage. \u201cOur findings suggest that improving follow-up RNA testing and integrating laboratory and pharmacy data will enhance accuracy and bridge gaps in hepatitis C testing and treatment,\u201d they wrote. \u201cHowever, when only one data source is available, viral clearance or treatment initiation can serve as reasonable substitutes for measuring viral clearance after treatment initiation.\u201d Perspective Back to Top It is important for health systems to understand how their population of individuals infected with HCV traverses the care cascade. However, mining these data can be challenging. In this study, Symum and colleagues address a fundamental operational question in viral hepatitis epidemiology: When measuring HCV care cascade outcomes at the population level, how do single-source surveillance metrics \u2014 lab-only vs. pharmacy-only \u2014 compare with linked, multimodal definitions of cure? Evaluating more than 51,000 insured U.S. adults with confirmed initial HCV infection from the HealthVerity database, the authors found that only 35.7% initiated DAA therapy and just 26.1% met the stringent metric of confirmed viral clearance following treatment. These findings highlight crucial surveillance nuances and persistent delivery system gaps. While SVR confirmed by laboratory testing after treatment remains the gold standard for clinical cure, requiring linked RNA confirmation introduces substantial underestimation in real-world registries. Nearly one in four patients (23.2%) who initiated DAA therapy had no subsequent RNA test on record. Because more than 90% of these unmonitored individuals filled at least 56 days of therapy \u2014 which reliably yields cure rates exceeding 95% in clinical practice \u2014 a significant proportion of successful cures are rendered invisible when demanding documented lab confirmation. For health systems or payers lacking linked longitudinal datasets, pharmacy claims for DAA dispensing serve as a practical, high-yield proxy for treatment success given current pan-genotypic regimen efficacy. Conversely, relying solely on unlinked laboratory clearance \u2014 observed in 39.9% of initial infections \u2014 captures treatment-induced clearance alongside spontaneous resolution and undocumented therapy, though it risks misclassification. As national elimination initiatives advance, relying strictly on end-to-end laboratory confirmation will falsely suppress perceived progress toward elimination targets. Integrated data infrastructure that marries pharmacy-dispensing records with automated laboratory reporting is essential. At the same time, health systems must implement simplified, reflex-testing workflows and targeted adherence tracking to close the persistent drop-off between active diagnosis and treatment completion in vulnerable populations. Nancy S. Reau, MD, FAASLD, AGAF Rush University Medical Center
Disclosures: Reau reports consulting for AbbVie, Bluejay Therapeutics, Gilead Sciences, Mallinckrodt, Salix Pharmaceuticals and Vir Biotechnology and receiving institutional research funding from AbbVie, Bluejay Therapeutics, Gilead Sciences, Salix Pharmaceuticals and Vir Biotechnology.
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