Reasons to wait or to treat naive patients affected by chronic hepatitis C with low fibrosis stage and genotypes 2 or 3.
New interferon (IFN)-free therapies are not currently available for all patients with chronic hepatitis C due to higher costs; in Italy, patients with genotype 2 (GT2) or GT3 without severe fibrosis can choose between wait or treatment with pegylated (PEG)-IFN and ribavirin. This study wants to examine the real rate of patients that accept or refused this therapy and the reasons related to decision.



This prospective, observational analysis was performed at our centre between January 2014 and June 2015. Epidemiological, social and clinical data were collected in medical records; reasons for treatment acceptance/refusal were recorded through a questionnaire. Eligible patients were: naïve, with genotypes 2 or 3, fibrosis stage F0-F2.



In total 132 patients were included: 34 with GT2, 98 with GT3. Patients with GT3 were younger, with prevalent sex male and mostly with active intravenous drug use. 53 patients accepted the treatment option (40.1%): 12 with GT2 (22%), 41 GT3 (41.8%) (P < 0.001). 79 patients refused (59.8%): 22 with GT2 (64.7%), 57 with GT3 (58.2) (P < 0.001). Fear of side-effects (OR = 1.774; 95% CI = 1.089-2.117; P = 0.016) and active alcoholism (OR = 1.144; 95% CI = 1.012-2.006; P = 0.025) were predictive factors for treatment refusal in GT3, whereas the presence of extrahepatic manifestations in GT2 (OR = 1.911; 95% CI = 1.124-2.912; P = 0.019) and the will to eradicate the infection in GT3 (OR = 2.140; 95% CI = 1.120-3.445; P = 0.008) were predictive of treatment acceptance.



Dual therapy is the only option for these subjects; however the motivation of patients and major socio-economic conditions were strictly related to decision of acceptance or refusal.
Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Turin, Italy.
Lucio
L
Boglione
Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Turin, Italy.
Jessica
J
Cusato
Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Turin, Italy.
Giuseppe
G
Cariti
Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Turin, Italy.
Giovanni
G
Di Perri
Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Turin, Italy.
Antonio
A
D'Avolio
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons