title: High deferral rates and poorer treatment outcomes for HCV patients with psychiatric and substance use comorbidities.
abstract: Many patients are excluded from HCV treatment due to psychiatric issues (PI) and substance abuse (SA). We sought to determine deferral rates and reasons for nontreatment, determine whether patients initially deferred for PI or SA subsequently received antiviral therapy, and compare treatment outcomes of these patients with patients who were not deferred. A retrospective analysis of 433 patients with HCV was conducted. Seventy-five percent of patients were deferred from treatment. Primary deferral reasons were PI (34.3%) and SA (33.6%). Characteristics were similar between eligible and ineligible treatment candidates. Of those initially deferred from therapy, over half returned for follow-up; however, only 13% eventually received treatment. Patients initially deferred for PI/SA but subsequently treated were less likely to complete treatment than patients without these comorbidities (48% vs. 13%). SVR was lower in patients with PI/SA compared to those without (26% vs. 47%). Deferral rates for PI/SA remain high, and these patients are rarely treated at subsequent clinic visits. When patients are deferred for PI/SA but later treated, they have significantly higher rates of not completing treatment and a trend toward lower SVR rates.
authors: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina 27599, USA. donna_evon@med.unc.edu
authors: Donna M
authors: DM
authors: Evon
authors: Amit
authors: A
authors: Verma
authors: Karen A
authors: KA
authors: Dougherty
authors: Betty
authors: B
authors: Batey
authors: Mark
authors: M
authors: Russo
authors: Steven
authors: S
authors: Zacks
authors: Roshan
authors: R
authors: Shrestha
authors: Michael W
authors: MW
authors: Fried
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D000998:Antiviral Agents; D007372:Interferons