12% of HCV-Infected Veterans Get Treated

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12% of HCV-Infected Veterans Get Treated

By Neil Osterweil, Senior Associate Editor, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University

of Pennsylvania School of Medicine.

November 04, 2007

BOSTON, Nov. 4 -- Only 12% of veterans infected with the hepatitis C

virus (HCV) were prescribed treatment for it, and less than one-

fourth of those treated completed a 48-week course of treatment,

investigators reported here.

A review of Veterans Affairs data on the rates and factors predicting

treatment completion for HCV showed that of 134,934 infected

veterans, only 16,043 were prescribed treatment, reported Adeel A.

Butt, M.D., of the University of Pittsburgh, and colleagues.

And among 10,461 vets with more than one year of follow-up, only

22.5% completed a full 48-week treatment course, the investigators

reported at the meeting of the American Association for the Study of

Liver Diseases.

Black veterans were less likely to complete therapy, as were those

with pre-treatment anemia, coronary artery disease, and a greater

number of co-morbidities.

The authors used the VA's national patient care database and other VA

data sets to create a cohort of veterans diagnosed with HCV from 1998

through 2003. They collected demographic and clinical information,

pharmacy data, and laboratory results, and conducted multivariate

analyses to determine which factors might predict completion of

therapy.

In multivariate analyses, the odds ratio for non-completion among

patients with anemia at baseline (hemoglobin 10-14 mg/dL) was 0.66

(95% confidence interval, 0.56-0.78), and for those with depression

the odds ratio for completing therapy was 0.78 (95%CI, 0.69 to 0.89).

Patients on pegylated interferon therapy were more likely to complete

treatment compared with those on standard interferons. There was no

association between HIV co-infection and the likelihood of treatment

completion, however.

The authors noted that at least some of the risk factors for non-

completion, such as anemia and depression, and smaller numbers of

patients being treated at the site are modifiable.

" Strategies to address these comorbidities should be instituted

before universal advocacy of HCV treatment for every infected person,

if therapeutic success at the population level is to be achieved, "

the investigators noted.

They called for further study of the effect of consolidating services

to higher volume centers that are experienced in such treatment, and

whether better training of workers at low volume centers could

improve treatment completion rates.

The study was funded by the Department of Veterans Affairs. The

authors had no disclosures.

Complete AASLD Coverage

Primary source: American Association for the Study of Liver Diseases

Source reference:

Butt AA et al. " Real-life Rates of Treatment Completion for HCV. "

Abstract 281, presented Nov. 3.