Psychosocial factors are the most common contraindications for antiviral therapy at initial evaluation in veterans with chronic hepatitis C.
OBJECTIVE
To understand the degree to which psychosocial factors were preventing veterans with chronic hepatitis C virus from being eligible for antiviral treatment.


BACKGROUND
Nearly 2% of the US population is infected with hepatitis C. Antiviral treatment requires substantial adherence despite challenging side effects. Psychosocial factors, including depression and substance abuse, are clinically recognized contraindications for antiviral treatment.


METHODS
At the Houston Veterans Affairs Medical Center HCV Clinic, we prospectively gathered medical and psychosocial data, as well as treatment disposition data, for consecutively referred patients who had screened positive for hepatitis C by enzyme-linked immunosorbent assay serology.


RESULTS
Of the 697 patients referred from September 2000 to May 2001, 580 had chronic hepatitis C. The mean age was 51 years, and 99% were men. Psychosocial contraindications prevented hepatitis C antiviral treatment from being started for 406 (70.0%) patients. These contraindications included alcohol abuse (124, 21.4%), substance abuse (21, 3.6%), and depression (93, 16.0%). Among the medical contraindications were end-stage liver disease (34, 5.9%) and poorly controlled diabetes mellitus (20, 3.4%).


CONCLUSIONS
Overall, our experience was that a significant portion of hepatitis C patients could not initially be started on antiviral treatment due to psychosocial factors. To make these patients eligible for treatment, future studies of multidisciplinary interventions are required.
Rowan
Paul J
PJ
Houston Veterans Affairs Medical Center, Houston, TX, USA.
Tabasi
Shahriar
S
Abdul-Latif
Mariam
M
Kunik
Mark E
ME
El-Serag
Hashem B
HB
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011584:Psychology; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D014728:Veterans
D000998:Antiviral Agents