title: HEPACOM: multicenter, observational prospective study of outcome and monitoring of HCV positive antiviral-naïve patients managed in the French health care system.
abstract: OBJECTIVE
  To study management practices in the French health care system for antiviral-naïve patients with chronic hepatitis C virus (HCV) infection.
  
  
  METHODS
  Two groups of general practitioners, group I (special training and experience in drug addiction) and group II (other general practitioners) enrolled untreated HCV positive patients and noted management practices for a 12-month period.
  
  
  RESULTS
  Among 4660 enrolled patients, 2038 enrolled by 462 general practitioners in group I and 1756 enrolled by 588 general practitioners in group II were retained for analysis. These patients were adults, aged 42+/-14 years, who were naïve to antiviral treatment. The male/female ratio was 1: 7. Ten percent were coinfected with HIV, 12% had excessive alcohol intake, and 61% were current drug users, 75% of whom (45% of the total population) were taking replacement therapy. Minimal hepatic lesions (stage<A2 and F2 in METAVIR scoring) were observed in 12% of the total population; cirrhosis in 13% of patients with significant fibrosis (>or=F2). At the end of the monitoring period, 64% of the patients had been referred to a specialist. Antiviral treatment had been started in 20%, i.e. 32% of the patients who consulted a specialist. Occupational activity (P<0.0001), young age (P=0.007), more recent diagnosis (P<0.0001), lack of HIV co-infection (P=0.015), male gender (P=0.006), lack of replacement treatment (P=0.006), previous liver histology with METAVIR A and F>or=2 (P<0.0001) and enrollment by a group I general practitioner (P<0.007) were the independent predictive factors of initiation of antiviral treatment.
  
  
  CONCLUSIONS
  Only one-third of patients with access to the French health care system started antiviral treatment and some categories of patients, including women, patients co-infected with HIV and patients on replacement therapy, were less likely to be treated than others. The recommendations of the French Consensus Conference, held in the middle of the study period (2002), might have been implemented (probably followed) by a minority of general practitioners.
authors.affiliation: Seillans Conseils, Paris.
authors.forename: Hélène
authors.initials: H
authors.lastname: Agostini
authors.forename: Laurent
authors.initials: L
authors.lastname: Castera
authors.forename: Pascal
authors.initials: P
authors.lastname: Melin
authors.forename: Laurent
authors.initials: L
authors.lastname: Cattan
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D000998:Antiviral Agents / Q000627:therapeutic use; D003695:Delivery of Health Care; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006679:HIV Seropositivity / Q000150:complications; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000150:complications / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents