Many veterans may not be candidates for Hepatitis C virus treatment due to contraindications to therapy.
Dr Edmund Bini determined the proportion of Hepatitis C-infected veterans who were eligible for interferon alfa and ribavirin therapy.
The investigators evaluated the barriers to Hepatitis C virus treatment.
The investigative team prospectively enrolled 4084 veterans who were referred for Hep C treatment over a 1-yr period at 24 Veterans Affairs Medical Centers.
Treatment candidacy was assessed using standardized criteria and the opinion of the treating clinician.
|Substance abuse is a strong predictor of not being a treatment candidate|
|American Journal of Gastroenterology|
The team reported that 32% were candidates for Hepatitis C treatment according to standardized criteria, and 41% were candidates in the opinion of the clinician.
The team used multivariable analysis to identify predictors of not being a treatment candidate.
The investigators found that ongoing substance abuse, and comorbid medical disease, were the strongest predictors of not being a treatment candidate.
In addition, the team noted psychiatric disease, and advanced liver disease as the strongest predictors of not being a treatment candidate.
Among patients who were considered treatment candidates, 76% agreed to be treated.
Using multivariable analysis in these patients, the team showed that persons 50 years of age are more likely to decline treatment.
The investigators noted that those with more than 50 lifetime sexual partners were more likely to decline treatment.
Dr Bini's team concludes, “The majority of veteran patients are not suitable candidates for Hepatitis C treatment because of substance abuse, psychiatric disease, and comorbid medical disease.”
“Many who are candidates decline therapy.”
“Multidisciplinary collaboration is needed to overcome barriers to Hepatitis C therapy in this population.”