Antiviral treatment for hepatitis C virus infection: effectiveness at general population level in a highly endemic area.
BACKGROUND
Peginterferon plus ribavirin treatment induced a sustained virological response in >50% of HCV-RNA-positive individuals enrolled in published clinical trials.


OBJECTIVE
To determine anti-HCV treatment effectiveness at a general population level.


METHODS
In 2002, a 1:5 random sample of >11 years old inhabitants of a small Italian town (Cittanova) was invited for HCV screening. HCV-RNA-positive individuals were evaluated for antiviral treatment.


RESULTS
1645 of 1924 invited individuals (85.5%) participated in the screening. 84 HCV-RNA-positive individuals were detected: median age was 65 years (range: 32-87); 67% was infected with genotype 1 or 4. Antiviral treatment was judged unnecessary for 43 (51.2%), due to persistently normal alanine aminotransferases, mild disease at liver biopsy or age >70 years without cirrhosis. Twenty-eight of the remaining 41 patients (68.3%) were ineligible for treatment, because of medical/psychiatric contraindications (42.9%), alcohol/drug abuse (17.9%), decompensated cirrhosis/hepatocellular carcinoma (17.9%), not attending official appointments (10.7%), previous intolerance/non-response to interferon plus ribavirin (10.7%). 5 of 13 eligible patients (38.5%) did not receive treatment (4 refused and 1 accidental death). 3 of 8 treated patients (37.5%) reached a sustained virological response.


CONCLUSIONS
Although efficacy of anti-HCV therapy improved in recent years, we found that low eligibility to treatment still limited its effectiveness at general population level in a highly endemic town.
Mariano
A
A
National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Health Institute, Rome, Italy. andrea.mariano@iss.it
Caserta
C
C
Pendino
G M
GM
Vacalebre
C
C
Surace
P
P
Fiorillo
M T
MT
Polito
I
I
Surace
M
M
Alicante
S
S
Amante
A
A
Foti
G
G
Marra
M
M
Gutamo
G
G
Amato
F
F
Messineo
A
A
Mele
A
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D019353:Endemic Diseases; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012254:Ribavirin / Q000627:therapeutic use*; D055815:Young Adult
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons