Who Gets Antiviral Treatment for Hepatitis C?

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The summary below is from the full report titled "Surprisingly Small Effect of Antiviral Treatment in Patients with Hepatitis C." It is in the 19 February 2002 issue of Annals of Internal Medicine (volume 136, pages 288-292). The authors are Y Falck-Ytter, H Kale, KD Mullen, SA Sarbah, L Sorescu, and AJ McCullough.

What is the problem and what is known about it so far?

Hepatitis is an inflammation of the liver that can be caused by several things, including alcohol, drugs, and viruses. Many people with hepatitis recover within a few months, but hepatitis can be chronic and progress to scarring of the liver (cirrhosis). Hepatitis C virus can cause chronic hepatitis infection, cirrhosis, or liver failure and can increase the risk for liver cancer. People become infected with the hepatitis C virus through sexual intercourse or by sharing contaminated needles with persons who are already infected. Strong antiviral drugs can kill hepatitis C virus, but these drugs are difficult to take and have many side effects. Patients taking these drugs must be followed closely and have liver biopsies analyzed. Doctors usually won't give antiviral drugs to people who drink too much, "shoot up" drugs, have severe liver disease or other serious medical problems, are pregnant or unwilling to practice contraception, or suffer from severe psychiatric problems. The studies showing that antiviral therapies work have been done in people without any of these problems. We do not know whether most patients with hepatitis C virus infection have such problems and cannot take antiviral therapy.

Why did the researchers do this particular study?

To find out how many patients with hepatitis C virus infection are good candidates for antiviral therapy.

Who was studied?

327 patients who were referred to a special liver clinic for possible antiviral treatment for hepatitis C virus infection. The clinic was in a large county hospital in Cleveland, Ohio.

How was the study done?

The researchers reviewed the medical records of patients who had been referred to the clinic in 1998 and 1999. They used notes of clinic doctors to determine how many patients were not treated and why.

What did the researchers find?

Of the 327 patients, 34 did not have chronic hepatitis C virus infection. Of the remaining patients, 72% were not treated with antiviral therapy. Patients were not treated for several reasons, including failure to show up for appointments or to have necessary tests (37%), severe medical or psychiatric problems (34%), ongoing alcohol or drug abuse (13%), or not wanting treatment (11%).

What were the limitations of the study?

The study setting was one large county clinic in an urban area. We do not know whether patients attending clinics in other areas would have the same or different characteristics.

What are the implications of the study?

Many patients with hepatitis C virus are not good candidates for antiviral therapies.