LAUSR

TO THE EDITOR: I read Kattakuzhy and colleagues' (1) article on the efficacy of HCV treatment provided by NPs, PCPs, and specialist physicians with great interest. Although I agree in principle with the authors' conclusions, making an informed decision on the efficacy of using other treatment providers on the basis of these data is difficult. The age of direct-acting antivirals has ensured that most patients receiving these drugs will attain a sustained virologic response (SVR). This may be especially true with the advent of glecaprevir and pibrentasvir, because phase 2 trials (such as MAGELLAN-1 [Glecaprevir and Pibrentasvir for 12 or 16 Weeks in Patients With Chronic HCV Genotype 1 or 4 and Prior Direct-Acting Antiviral Treatment Failure]) show SVR rates up to 100% (2). Rather than SVR rates, I believe that the rate of adverse events (AEs) stratified by treatment provider is the most useful indicator for determining the efficacy of alternative treatment providers. This information is unfortunately not available in the article. Moreover, even if it were available, AEs were self-reported by the treatment provider to the investigators, thus making these results subject to reporting bias. Recognizing that drugdrug interactions are common with direct-acting antivirals and that AEs related to these interactions can compromise patient safety is important (3). Patients receiving drugs contraindicated with the use of ledipasvir and sofosbuvir were excluded. However, many other drug interactions can still occur, and these may (or may not) be better recognized by specialist physicians. The use of nonspecialist health care professionals in treating HCV infection in the community is undoubtedly the future direction of care given the advent of direct-acting antivirals. Yet, more data are needed on the holistic efficacy of care from all providers, including those on AEs by treatment provider. From these data, educational constructs can be created to ensure that all treatment providers deliver the same standard of care. Nevertheless, I commend Kattakuzhy and colleagues and look forward to their future publications.