title: Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection.
abstract: BACKGROUND
  Many veterans may not be candidates for hepatitis C virus (HCV) treatment due to contraindications to therapy. The aims of this study were to determine the proportion of HCV-infected veterans who were eligible for interferon alfa and ribavirin therapy and to evaluate barriers to HCV treatment.
  
  
  METHODS
  We prospectively enrolled 4,084 veterans who were referred for HCV treatment over a 1-yr period at 24 Veterans Affairs (VA) Medical Centers. Treatment candidacy was assessed using standardized criteria and the opinion of the treating clinician.
  
  
  RESULTS
  Overall, 32.2% (95% CI, 30.8-33.7%) were candidates for HCV treatment according to standardized criteria, whereas 40.7% (95% CI, 39.2-42.3%) were candidates in the opinion of the treating clinician. Multivariable analysis identified ongoing substance abuse (OR = 17.68; 95% CI, 12.24-25.53), comorbid medical disease (OR = 9.62; 95% CI, 6.85-13.50), psychiatric disease (OR = 9.45; 95% CI, 6.70-13.32), and advanced liver disease (OR = 8.43; 95% CI, 4.42-16.06) as the strongest predictors of not being a treatment candidate. Among patients who were considered treatment candidates, 76.2% (95% CI, 74.0-78.3%) agreed to be treated and multivariable analysis showed that persons >/=50 yr of age (OR = 1.37; 95% CI, 1.07-1.76) and those with >50 lifetime sexual partners (OR = 1.44; 95% CI, 1.08-1.93) were more likely to decline treatment.
  
  
  CONCLUSIONS
  The majority of veteran patients are not suitable candidates for HCV treatment because of substance abuse, psychiatric disease, and comorbid medical disease, and many who are candidates decline therapy. Multidisciplinary collaboration is needed to overcome barriers to HCV therapy in this population.
authors.affiliation: VA New York Harbor Healthcare System and NYU School of Medicine, New York, New York 10010, USA.
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Bini
authors.forename: Norbert
authors.initials: N
authors.lastname: Bräu
authors.forename: Sue
authors.initials: S
authors.lastname: Currie
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.forename: Bhupinderjit S
authors.initials: BS
authors.lastname: Anand
authors.forename: Ke-Qin
authors.initials: KQ
authors.lastname: Hu
authors.forename: Lennox
authors.initials: L
authors.lastname: Jeffers
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Warren N
authors.initials: WN
authors.lastname: Schmidt
authors.forename: Paul
authors.initials: P
authors.lastname: King
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Morgan
authors.forename: Joseph
authors.initials: J
authors.lastname: Awad
authors.forename: Marcos
authors.initials: M
authors.lastname: Pedrosa
authors.forename: Kyong-Mi
authors.initials: KM
authors.lastname: Chang
authors.forename: Ayse
authors.initials: A
authors.lastname: Aytaman
authors.forename: Franz
authors.initials: F
authors.lastname: Simon
authors.forename: Curt
authors.initials: C
authors.lastname: Hagedorn
authors.forename: Richard
authors.initials: R
authors.lastname: Moseley
authors.forename: Jawad
authors.initials: J
authors.lastname: Ahmad
authors.forename: Charles
authors.initials: C
authors.lastname: Mendenhall
authors.forename: Bradford
authors.initials: B
authors.lastname: Waters
authors.forename: Doris
authors.initials: D
authors.lastname: Strader
authors.forename: Anna W
authors.initials: AW
authors.lastname: Sasaki
authors.forename: Stephen
authors.initials: S
authors.lastname: Rossi
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Wright
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D000075202:Contraindications; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D012254:Ribavirin / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome; D014481:United States; D014728:Veterans
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin