Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection.
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.
Bini
Edmund J
EJ
VA New York Harbor Healthcare System and NYU School of Medicine, New York, New York 10010, USA.
Bräu
Norbert
N
Currie
Sue
S
Shen
Hui
H
Anand
Bhupinderjit S
BS
Hu
Ke-Qin
KQ
Jeffers
Lennox
L
Ho
Samuel B
SB
Johnson
David
D
Schmidt
Warren N
WN
King
Paul
P
Cheung
Ramsey
R
Morgan
Timothy R
TR
Awad
Joseph
J
Pedrosa
Marcos
M
Chang
Kyong-Mi
KM
Aytaman
Ayse
A
Simon
Franz
F
Hagedorn
Curt
C
Moseley
Richard
R
Ahmad
Jawad
J
Mendenhall
Charles
C
Waters
Bradford
B
Strader
Doris
D
Sasaki
Anna W
AW
Rossi
Stephen
S
Wright
Teresa L
TL
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
D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin