Drs Omar Khokhar and James Lewis from Washington DC determined the percentage of treatment-naïve patients infected with chronic Hepatitis C virus.
The patients made an informed choice to defer treatment with pegylated interferon regimens in the absence of any medical, psychosocial, or other contraindications.
The investigative team reassessed the patients' decision by using a questionnaire at least 1 year later.
The team retrieved patient charts dating from 2001.
The investigators retrospectively analyzed patient age, gender, race, Hepatitis C viral load, genotype, and liver biopsy results.
The team also evaluated hepatic imaging results, and peak alanine aminotransferase levels.
Comorbid conditions, source of infection, and estimated duration of infection were assessed.
In addition, the team determined reasons given by the patient for declining pegylated interferon-based treatment at the time of their consultation.
The team used a questionnaire survey to determine the patients' satisfaction with their initial decision.
|41% otherwise eligible for therapy opted to defer|
|Digestive Diseases and Sciences|
Of 446 patient charts reviewed, 280 patients were treatment-naïve, and were judged to have no contraindications to receiving interferon-based therapy.
Of these, 115 opted to defer treatment, and are the subject of this analysis.
The team found women declining therapy outnumbered men by approximately 3 to 2.
Middle-aged patients were most likely to choose expectant therapy compared with older or younger individuals.
The team found that the 48% of African American patients who deferred therapy vs 37% of non-African American patients.
More than 90% of the patients choosing to be followed were genotype 1.
The team noted that peak alanine aminotransferase values were normal in 37%, and less than 2 times the upper limits of normal in another 40%.
The estimated duration of chronic Hepatitis C infection was over 16 years in approximately 75% of individuals.
The investigators found that the most common source of the patients' infection was intravenous drug use followed by transfusion-related.
The most common reason for opting not to receive treatment was the asymptomatic nature of their infection.
The team noted that this concern was coupled with the patient's concern about side effects of the medications.
Approximately 10% had unfavorable social situations, including a lack of support or health insurance.
Only 4% of patients cited doubts about efficacy as the main reason that they did not want to be treated.
The team found after 1 year that 79% of the patients confirmed their ongoing satisfaction with their initial decision to decline treatment.
Another 11% of patients indicated that they were still ‘moderately satisfied' with their decision, and unlikely to change it in the near-future.
The investigators noted that only 7% of patients voiced their current dissatisfaction with expectant management.
These patients expressed the desire to have a follow-up discussion about treatment options.
The remaining 4% of patients already started treatment or were deceased of non-liver-related causes.
The investigators found that 41% of patients infected with Hepatitis C virus who are otherwise eligible for therapy opted to defer treatment.
Dr Omar Khokhar and colleague concluded, “A significant proportion of patients infected with Hepatitis C opt to defer treatment.”
“African American patients defer in a higher proportion than non-African American patients.”
“Nearly all of our patients were genotype 1 with clinically and histologically mild hepatitis of reasonably long duration.”
“Our questionnaire survey found that most remained satisfied with their decision to defer treatment at the present time.”
“Few patients cited a perceived low rate of efficacy of pegylated interferon and ribavirin therapy as the principal reason that they chose not to initiate treatment.”