title: Rate, delay and predictors of hepatitis C treatment in British Columbia.
abstract: BACKGROUND
  The current treatment rate for chronic hepatitis C virus (HCV) infection is suboptimal despite the availability of efficacious antiviral therapy.
  
  
  OBJECTIVE
  To determine the rate, delay and predictors of treatment in patients with chronic HCV infection.
  
  
  METHODS
  A retrospective chart review of chronic HCV patients who were being evaluated at a tertiary hepatology centre in Vancouver, British Columbia, was performed.
  
  
  RESULTS
  One hundred sixty-four patients with chronic HCV infection who were assessed for treatment between February 2008 and January 2013 were reviewed. Treatment was initiated in 25.6% (42 of 164). In multivariate analyses, male sex (OR 7.90 [95% CI 1.35 to 46.15]) and elevated alanine aminotransferase (ALT) level (>1.5 times the upper limit of normal) (OR 3.10 [95% CI 1.32 to 7.27]) were positive predictors of treatment, whereas active smoking (OR 0.09 [95% CI 0.02 to 0.53]) and Charlson comorbidity index (per point increase) (OR 0.47 [95% CI 0.27 to 0.83]) were negative predictors of treatment. The most common reasons for treatment deferral were no or minimal liver fibrosis in 57.7% (n=30), persistently normal ALT levels in 57.7% (n=30) and patient unreadiness in 28.8% (n=15). The most common reasons for treatment noninitiation were patient refusal in 59.1% (n=26), medical comorbidities in 36.4% (n=16), psychiatric comorbidities in 9.1% (n=4) and decompensated cirrhosis in 9.1% (n=4). There was a statistically significant difference in the median time delay from HCV diagnosis to general practitioner referral between the treated and untreated patients (66.3 versus 119.5 months, respectively [P=0.033]). The median wait time from general practitioner referral to hepatologist consult was similar between the treated and untreated patients (1.7 months versus 1.5 months, respectively [P=0.768]). Among the treated patients, the median time delay was 6.8 months from hepatologist consult to treatment initiation.
  
  
  CONCLUSIONS
  The current treatment rate for chronic HCV infection remains suboptimal. Medical and psychiatric comorbidities represent a major obstacle to HCV treatment. Minimal hepatic fibrosis may no longer be a major reason for treatment deferral as more efficacious and tolerable antiviral therapies become available in the future. Greater educational initiatives for primary care physicians would promote early referral of patients. More nursing support would alleviate the backlog of patients awaiting treatment.
authors: Alan Hoi Lun
authors: AH
authors: Yau
authors: Terry
authors: T
authors: Lee
authors: Alnoor
authors: A
authors: Ramji
authors: Hin Hin
authors: HH
authors: Ko
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D001955:British Columbia / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005355:Fibrosis / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D000998:Antiviral Agents; D000410:Alanine Transaminase