Hepatitis C infection: eligibility for antiviral therapies.
BACKGROUND
Current treatments of chronic hepatitis C virus (HCV) are effective, but expensive and susceptible to induce significant side effects.


OBJECTIVE
To evaluate the proportion of HCV patients who are eligible for a treatment.


METHODS
In a database comprising 1726 viraemic HCV patients, the files of 299 patients who presented to the same hepatologist for an initial appointment between 1996 and 2003 were reviewed.


RESULTS
Patients' characteristics were age 43.1 +/- 15.6 years, 53% male and 92% Caucasian. The main risk factors were transfusion (43%) and drug use (22%). Genotypes were mostly genotype 1 (66%), genotype 3 (12%) and genotype 2 (10%). These characteristics were not different from those of the whole series of 1726 patients. A total of 176 patients (59%) were not treated, the reasons for non-treatment being medical contraindications (34%), non-compliance (25%) and normal transaminases (24%). In addition, 17% of patients declined therapy despite being considered as eligible, mainly due to fear of adverse events. Medical contraindications were psychiatric (27%), age (22%), end-stage liver disease (15%), willingness for pregnancy (13%), cardiac contraindication (7%) and others (16%). Only 123 patients (41%) were treated. A sustained viral response was observed in 41%. The treatment was interrupted in 16% for adverse events.


CONCLUSIONS
The majority of HCV patients are not eligible for treatment. This implies that, with current therapies, only 17% of patients referred for chronic HCV become sustained responders. Some modifications of guidelines could extend the rate of treatment (patients with normal transaminases), but an important barrier remains the patients' and the doctors' fear of adverse events.
Delwaide
Jean
J
Department of Hepato-Gastroenterology, CHU Sart Tilman, Université de Liège, Belgium. jean.delwaide@chu.ulg.ac.be
El Saouda
Refaat
R
Gérard
Christiane
C
Belaïche
Jacques
J
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D016312:Treatment Refusal
D000998:Antiviral Agents; D000637:Transaminases