title: Chronic hepatitis C: treat or wait? Medical decision making in clinical practice.
abstract: OBJECTIVE
  To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.
  
  
  METHODS
  This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α 2a/ribavirin, involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings). A structured questionnaire had to be answered prior to the treatment decision, which included demographic data, information about the personal life situation of the patients, anamnesis and symptomatology of hepatitis C, virological data, laboratory data and data on concomitant diseases. A second part of the study analyzes patients treated with pegylated interferon α2a. All questionnaires included reasons against treatment mentioned by the physician.
  
  
  RESULTS
  Overall treatment uptake was 45%. By multivariate analysis, genotype 1/4/5/6, HCV-RNA ≤ 520,000 IU/mL, normal alanine aminotransferase (ALT), platelets ≤ 142,500/μL, age > 56 years, female gender, infection length > 12.5 years, concomitant diseases, human immunodeficiency virus co-infection, liver biopsy not performed, care in private practice, asymptomatic disease, and unemployment were factors associated with reduced treatment rate. Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems. Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.
  
  
  CONCLUSIONS
  Some reasons against treatment were medically based whereas others were related to fears, socio-economical problems, and information deficits both on the side of physicians and patients.
authors.affiliation: Katholische Kliniken Oberhausen, St. Josef Hospital, Klinik für Innere Medizin, Oberhausen 46045, Germany. claus.niederau@st-josef.de
authors.forename: Claus
authors.initials: C
authors.lastname: Niederau
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hüppe
authors.forename: Elmar
authors.initials: E
authors.lastname: Zehnter
authors.forename: Bernd
authors.initials: B
authors.lastname: Möller
authors.forename: Renate
authors.initials: R
authors.lastname: Heyne
authors.forename: Stefan
authors.initials: S
authors.lastname: Christensen
authors.forename: Rainer
authors.initials: R
authors.lastname: Pfaff
authors.forename: Arno
authors.initials: A
authors.lastname: Theilmeier
authors.forename: Ulrich
authors.initials: U
authors.lastname: Alshuth
authors.forename: Stefan
authors.initials: S
authors.lastname: Mauss
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005858:Germany; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D016079:Refusal to Treat; D012254:Ribavirin / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a