title: Antiviral treatment for hepatitis C virus infection: effectiveness at general population level in a highly endemic area.
abstract: 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.
authors.affiliation: National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Health Institute, Rome, Italy. andrea.mariano@iss.it
authors.forename: A
authors.initials: A
authors.lastname: Mariano
authors.forename: C
authors.initials: C
authors.lastname: Caserta
authors.forename: G M
authors.initials: GM
authors.lastname: Pendino
authors.forename: C
authors.initials: C
authors.lastname: Vacalebre
authors.forename: P
authors.initials: P
authors.lastname: Surace
authors.forename: M T
authors.initials: MT
authors.lastname: Fiorillo
authors.forename: I
authors.initials: I
authors.lastname: Polito
authors.forename: M
authors.initials: M
authors.lastname: Surace
authors.forename: S
authors.initials: S
authors.lastname: Alicante
authors.forename: A
authors.initials: A
authors.lastname: Amante
authors.forename: G
authors.initials: G
authors.lastname: Foti
authors.forename: M
authors.initials: M
authors.lastname: Marra
authors.forename: G
authors.initials: G
authors.lastname: Gutamo
authors.forename: F
authors.initials: F
authors.lastname: Amato
authors.forename: A
authors.initials: A
authors.lastname: Messineo
authors.forename: A
authors.initials: A
authors.lastname: Mele
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons