Differing Epidemiology of Chronic Hepatitis C Infection, Treatment, and Outcomes Among Migrants and Australian-Born Patients

Abstract

The burden of hepatitis C virus (HCV) infection often falls disproportionately on migrant populations within high-income countries. Differences in health literacy, language, comorbidities, and HCV genotype may influence HCV natural history. 3537 persons including 652 migrants treated for HCV infection with direct-acting antiviral (DAA) (2016–2021) were analysed. We describe the epidemiology of HCV in migrant people compared to Australian-born individuals and examine rates of sustained viral response (SVR), advanced liver fibrosis, cirrhosis, and all-cause mortality. Multivariable logistic and Cox regression analyses examined differences by migrant status. At enrolment, Australian-born patients were younger (mean 51.5 vs. 54.2 years; p < 0.001) and more likely to report injection drug use (p = 0.011), risky alcohol use (p < 0.001), or opioid replacement therapy (p < 0.001). Among migrants, diabetes (13.9% vs. 10.3%; p = 0.008), hepatitis B virus (HBV) exposure (43.3% vs. 29.7%; p < 0.001), active HBV infection (3.1% vs. 1.6%; p = 0.033), and genotypes 4, 5, and 6 (18.3% vs. 6.6%; p < 0.001) was more common. Overall SVR rates were comparable (p = 0.69), but SVR rates among migrants with cirrhosis were lower (88.2% vs. 95.2%; p = 0.002). Advanced fibrosis (24.5%), cirrhosis (35.0%), and five-year survival did not differ by migrant status (all p > 0.05). In migrants, genotype 3 was associated with more advanced liver fibrosis (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), relative to Australian-born patients. Genotypes 2, 4 and 6 HCV were not associated with liver fibrosis and cirrhosis (all p > 0.05). In conclusion, migrants experienced equivalent SVR and rates of liver fibrosis and cirrhosis, and have equivalent or better survival compared to Australian-born patients.