title: Factors Associated with Failure to Achieve SVR in Hepatitis C Genotype 3 Patients Within an Integrated Care Delivery System.
abstract: BACKGROUND
  Achievement of sustained virologic response (SVR) and factors associated with treatment failure in hepatitis C virus (HCV) genotype 3 have been described in tertiary and referral care settings, with rates of SVR reported to range between 72% and 89%. Fewer data exist on SVR outside of these settings.
  
  
  OBJECTIVE
  To describe rates of SVR and characterize factors associated with achievement of SVR within an integrated health care delivery system.
  
  
  METHODS
  A retrospective cohort study of genotype 3 HCV patients treated with dual therapy (pegylated interferon-alpha plus ribavirin) was conducted at Kaiser Permanente Southern California. Adult patients diagnosed with HCV and testing positive for HCV-RNA genotype 3 were identified from electronic medical records. Data were collected on patient demographics, baseline health status, and comorbid conditions. A multivariate logistic regression model was used to determine the association between baseline patient factors and SVR.
  
  
  RESULTS
  A total of 484 HCV genotype 3 patients met the eligibility criteria. The median age was 49 years, and 65.7% were male. Overall, 252 (52.1%) achieved SVR. Aged ≥ 45 years and male gender were associated with lower rates of SVR; cirrhosis and chronic diseases (diabetes and chronic obstructive pulmonary disease) were also associated with lower rates of SVR.
  
  
  CONCLUSIONS
  SVR was lower in patients within an integrated care delivery system than in those in tertiary and referral centers. Males and older patients had lower rates of SVR, as well as patients with cirrhosis, diabetes, and chronic obstructive pulmonary disease.
authors.affiliation: Southern California Permanente Medical Group, 100 S. Los Robles Ave., 2nd Fl., Pasadena, CA 91101-2453. Craig.T.Cheetham@kp.org.
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
authors.forename: Fang
authors.initials: F
authors.lastname: Niu
authors.forename: Kevin
authors.initials: K
authors.lastname: Chiang
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.forename: Anu
authors.initials: A
authors.lastname: Kalsekar
authors.forename: Rulin
authors.initials: R
authors.lastname: Hechter
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
authors.forename: Lisa
authors.initials: L
authors.lastname: Nyberg
mesh_terms: D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D006279:Health Maintenance Organizations; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D012254:Ribavirin