title: Frequency and predictors of no treatment in anti-hepatitis C virus-positive patients at tertiary liver centers in Greece.
abstract: OBJECTIVE
  Despite the improving efficacy of antiviral therapy, a significant proportion of chronic hepatitis C patients never start treatment. We determined the magnitude and reasons for no treatment in anti-hepatitis C virus (HCV)-positive patients visiting tertiary liver centers in Greece.
  
  
  METHODS
  We retrospectively enrolled 1146 consecutive anti-HCV-positive patients who visited four physicians at two tertiary liver centers between 2002 and 2010.
  
  
  RESULTS
  Treatment was initiated in 628 (55%) of the 1146 patients. In particular, 309 (27%) patients were lost to follow-up before HCV RNA testing. Independent predictors of no HCV RNA testing were first visit before 2007, parenteral drug use, and the treating physician. Of the 837 patients tested for HCV RNA, 768 (92%) were eligible for antiviral therapy, had detectable serum HCV RNA, and no contraindication to treatment. Among them, 140 (18%) patients were lost to follow-up before the initiation of treatment or refused antiviral therapy. Independent predictors of no treatment were the treating physician, absence of liver biopsy or transient elastography (odds ratio: 3.5, 95% confidence interval: 2.3-5.4, P<0.001), and normal compared with elevated alanine transaminase levels (odds ratio: 1.7, 95% confidence interval: 1.1-2.8, P=0.027).
  
  
  CONCLUSIONS
  A significant proportion (>40%) of anti-HCV-positive patients visiting Greek tertiary liver centers do not receive antiviral therapy. Most of them are lost during the initial evaluation process, whereas the majority (>80%) of eligible patients who complete the initial evaluation eventually start antiviral therapy. The probability of treatment seems to be significantly associated with the treating physician, the alanine transaminase levels, and whether liver biopsy or transient elastography was performed.
authors: 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital, Athens, Greece.
authors: Nikolaos
authors: N
authors: Papadopoulos
authors: Spilios
authors: S
authors: Manolakopoulos
authors: Melanie
authors: M
authors: Deutsch
authors: Maria
authors: M
authors: Mela
authors: Aggeliki
authors: A
authors: Christidou
authors: Athina
authors: A
authors: Katoglou
authors: Dimitrios
authors: D
authors: Tzourmakliotis
authors: George V
authors: GV
authors: Papatheodoridis
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004363:Drug Utilization / Q000706:statistics & numerical data; D054459:Elasticity Imaging Techniques; D005260:Female; D006115:Greece; D016174:Hepacivirus / Q000302:isolation & purification; D018937:Hepatitis C Antibodies / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase