title: Gaps in the achievement of effectiveness of HCV treatment in national VA practice.
abstract: OBJECTIVE
  Antiviral treatment for hepatitis C virus (HCV) has high efficacy rates for achieving sustained viral response (SVR) in randomized controlled trials (RCTs) (40-80%); however, it can be lower in community-based practice settings. We wanted to determine the effectiveness of HCV treatment in Veterans Administration (VA) hospitals nationwide.
  
  
  METHODS
  Using the nationwide VA HCV Clinical Case Registry (CCR), we examined a cohort of veterans who had HCV viremia between 2000 and 2005 and identified patients who received pegylated-interferon (PEG-INF) and ribavirin. The duration of treatment and proportion of patients completing treatment was calculated. The effectiveness of treatment was measured as the proportion of patients who achieved SVR (negative viremia at least 12 weeks after the end of treatment) in the entire cohort, and among patients who initiated and completed treatment.
  
  
  RESULTS
  We identified 99,166 patients with HCV viremia. Of those, 11.6% received PEG-INF with ribavirin and 6.4% completed treatment. Contraindications were present in 57.2% of the patients that did not receive treatment. SVR was documented in 39.9% and 58.3% of patients who completed treatment; 23.6% and 50.6% of patients who initiated treatment; and 3.9% and 11.2% of the entire HCV cohort for genotype 1 or 4 and 2 or 3, respectively. Overall, only 3.5% of the entire HCV viremic cohort had a documented SVR.
  
  
  CONCLUSIONS
  Treatment effectiveness for HCV is low. In addition to fixed factors, such as race and virus genotype, the drop in effectiveness is due to low rates of antiviral treatment initiation and treatment completion.
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, United States. jkramer@bcm.edu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.forename: Minghua
authors.initials: M
authors.lastname: Mei
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014766:Viremia / Q000188:drug therapy / Q000821:virology
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin