Hepatitis C Treatment Outcomes for Patients With Infective Endocarditis Treated by an Interdisciplinary Team

Background. Patients with endocarditis often have comorbid injection substance use and are at risk for hepatitis C virus (HCV) infection. This population may encounter several significant barriers to treatment. To improve access to treatment, we developed an interdisciplinary collaboration between specialty pharmacy and the University of Kentucky endocarditis team and conducted a retrospective study evaluating treatment outcomes. Methods. Beginning in September 2021, the endocarditis team worked with specialty pharmacy to connect inpatients with endocarditis and HCV to expedited treatment and coordinated outpatient follow-up. Study investigators then retrospectively reviewed data consisting of patient demographics and treatment outcomes. Results. Between September 2021 and April 2024, 64 patients with infective endocarditis and HCV were identified (median age, 37 years; 41% female, 97% with a history of injection drug use). Upon discharge, 75% (48 of 64) initiated treatment. Treatment was completed in 69% (33 of 48) of these patients. The main reasons for discontinuation included loss to follow-up (n = 10) and medication side effects (n = 3). Sustained virologic response at 12 weeks was achieved in 42% (n = 20) of patients who initiated treatment and 31% of all patients. Among 22 patients with available laboratory results at 12 weeks posttreatment, 91% (n = 20) were HCV RNA negative. Conclusions. Despite efforts promoting expedited treatment and interdisciplinary coordination of care, sustained virologic response rates for patients with endocarditis and HCV infection remained <40%. More research is required to determine if interventions such as starting therapy during inpatient stay or immediately upon discharge and dispensing the entire course of medication at once can improve treatment outcomes.