Hepatitis C Treatment at a Veterans Affairs Medical Center After the Availability of Direct-Acting Agents: Things Are Looking Up

ministration (VHA) is the single largest provider of hepatitis C virus (HCV) care within the United States, with a 5.4 % se-roprevalence rate for all veterans, which is 3-fold greater than that of the general US population [1]. With this high HCV prevalence and known subsequent com-plications of cirrhosis, end-stage liver disease, hepatocellular carcinoma, and in-creased mortality [2], VHA issued Direc-tive 2013–1300.01, committing VHA to expand access to treatment and improve prevention, diagnosis, care, and treat-ment of viral hepatitis across its health-care system. Sofosbuvir was approved for HCV treatment in December 2013 and was followed by simeprevir, sofosbuvir-ledipasvir, and ombitasvir-paritaprevir-ritonavir plus dasabuvir in 2014; all have been added to the VHA National Formu-lary. These direct-acting agents (DAAs) allow for interferon-sparing oral therapy to effectively treat HCV infection. We as-sessed the rates of HCV treatment at the VA Medical Center in Washington, D.C. (DC-VAMC), before and after the avail-ability of interferon-sparing oral DAA regimens. After approval by the Institutional Re-view Board and the Research and Devel-opment Committee at the DC-VAMC, a retrospective review of all HCV-infected patients in care at the DC-VAMC fro