Who Gets Treated for Hepatitis C?

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Who Gets Treated for Hepatitis C?

By Liz Highleyman

Many people with chronic hepatitis C virus (HCV) infection never

receive treatment, for reasons ranging from minimal liver damage, to

active substance use, to doctors fears about poor adherence.

As reported in the September 26, 2006 electronic edition of Gut,

researchers conducted a study to determine the rate of hepatitis C

treatment prescription and predictors of treatment in a large cohort

of U.S. veterans. They used the Department of Veterans Affairs (VA)

National Patient Care Database to identify all HCV-infected persons

receiving care between 1999 and 2003. Demographic information,

medical and psychiatric co-morbidities, and drug and alcohol use

diagnoses were retrieved from patient records. Pharmacy data was

retrieved from the VA Pharmacy Benefits Management database.

Results

• 113,927 veterans under VA care with a diagnosis of HCV were

identified.

• The treatment prescription rate for hepatitis C was 11.8%.

• Patients not prescribed treatment were:

- Older;

- More likely to be of a minority race;

- More likely to use alcohol and/or illegal drugs;

- More likely to have medical and psychiatric co-morbid conditions.

• In a multivariate logistic regression model, the following factors

predicted non-treatment of HCV:

- Increasing age (OR 0.77 for each 5 year increment);

- Black (OR 0.64) or Hispanic (OR 0.88) race;

- Alcohol (OR 0.62) or drug (OR 0.78) " abuse and dependence " ;

- Presence of anemia (OR 0.18);

- Hepatitis B co-infection (OR 0.72);

- History of stroke (OR 0.75);

- Coronary artery disease (OR 0.90);

- Mild depression (OR 0.56);

- Major depression (OR 0.72);

- Bipolar disorder (OR 0.64);

- Schizophrenia (OR 0.71).

• Factors associated with a higher likelihood of treatment for HCV

were:

- Liver cirrhosis (OR 1.60);

- Diabetes (OR 1.07).

Conclusion

In conclusion, the authors wrote, " A small number of HCV infected

veterans are prescribed treatment for HCV. Non-treatment is

associated with increasing age, black race, drug and alcohol abuse

and dependence and co-morbid illnesses. "

These results suggest that many patients with hepatitis C are

needlessly missing out on the benefits of treatment. The most recent

National Institutes of Health consensus statement on hepatitis C

treatment no longer recommends that active substance users be

categorically excluded from anti-HCV therapy.

Medical conditions like anemia and psychiatric conditions like

depression do present additional challenges during treatment, but in

many cases these can be managed with adjunct medications such as

antidepressants.

10/20/06