Current practice of hepatitis C treatment in Southern Italy.
BACKGROUND
Only a small proportion of subjects referring to hospitals for hepatitis C virus (HCV) positivity receives antiviral therapy.


OBJECTIVE
To evaluate the rate of antiviral treatment and the causes for no treatment in HCV-RNA positive subjects seen in hospital settings.


METHODS
A prospective study enrolling over a 6-month period (February-July 2009) all consecutive anti-HCV positive subjects initially referred (naïve patients) to 12 liver units in Southern Italy for HCV treatment.


RESULTS
Out of 608 subjects evaluated, 74 (12.2%) had no detectable HCV-RNA in the serum and thus were excluded. Of the remaining 534 HCV-RNA positive subjects, 357 (66.9%) were not treated for the following reasons: 49.9% were older than 65 years of age (75% of them >70 years), 14.3% had normal liver enzymes, 13.2% had compensated/decompensated cirrhosis, 10.4% refused treatment, 9.8% had ongoing substance or alcohol abuse. Multivariate analysis showed that females (O.R. 2.27; C.I. 95% 1.05-4.90) and subjects with low educational level (O.R. 4.38; C.I. 95% 1.27-15.11) were more likely to decline therapy.


CONCLUSIONS
The majority of patients with HCV infection does not receive antiviral treatment. The effectiveness of the current standard therapy for HCV infection is low despite its good efficacy.
Stroffolini
Tommaso
T
Department of Infectious and Tropical Diseases, Policlinico Umberto I, Rome, Italy. tommaso.stroffolini@iss.it
Spadaro
Aldo
A
Guadagnino
Vincenzo
V
Cosentino
Stefano
S
Fatuzzo
Filippo
F
Galdieri
Antonio
A
Cacopardo
Bruno
B
Scalisi
Ignazio
I
Sapienza
Mauro
M
Russello
Maurizio
M
Scifo
Gaetano
G
Frugiuele
Pierluigi
P
Foti
Giuseppe
G
Almasio
Piero Luigi
PL
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000437:Alcoholism; D000998:Antiviral Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D004522:Educational Status; D005260:Female; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use; D012737:Sex Factors; D016896:Treatment Outcome; D016312:Treatment Refusal
D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D000410:Alanine Transaminase; C417083:peginterferon alfa-2b