Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Falck-Ytter, Y.    McCullough, A. J.    Related Articles in PubMed    PubMed Citation    PubMed

BRIEF COMMUNICATION

Surprisingly Small Effect of Antiviral Treatment in Patients with Hepatitis C

Yngve Falck-Ytter, MD; Hemangi Kale, MD; Kevin D. Mullen, MD; Steedman A. Sarbah, MD; Lucian Sorescu, MD; and Arthur J. McCullough, MD

19 February 2002 | Volume 136 Issue 4 | Pages 288-292

Background: The effect and applicability of interferon-based antiviral therapies in the general population of persons with hepatitis C virus (HCV) infection are unknown.

Objective: To determine the applicability and usefulness of anti-viral therapy in a metropolitan clinic population.

Design: Retrospective case series of consecutively referred patients.

Setting: A teaching county hospital in Cleveland, Ohio.

Patients: 327 patients referred to a liver clinic after a positive result for antibody against HCV on enzyme-linked immunosorbent assay (ELISA).

Measurements: Treatment rates; reasons for nontreatment.

Results: 34 patients had no detectable HCV RNA. Of the remaining 293 patients, 72% were not treated for the following reasons: 37% did not adhere to evaluation procedures, 34% had medical or psychiatric contraindications, 13% had ongoing substance or alcohol abuse, 11% preferred no treatment, and 5% had normal liver enzyme levels. Only 83 patients (28%) were treated; 13% had a sustained viral response.

Conclusion: Most patients with HCV infection are not candidates for interferon-based therapies; alternative interventions should be sought for these patients.

Editors' Notes Context Hepatitis C virus is the most common cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma in the United States. Trials show that about 50% of patients with chronic hepatitis C virus infection respond to prolonged treatment with antiviral drugs, such as pegylated interferon and ribavirin. Physicians are selective about whom to treat because antiviral therapy is expensive and difficult to take and has many side effects. Contribution This study shows that 72% of patients with hepatitis C virus infection who attended an urban county clinic did not receive antiviral therapy because of failure to show up for appointments or tests, severe comorbid medical or psychiatric illness, ongoing alcohol or drug abuse, or preferences against treatment. Implications Most patients with chronic hepatitis C virus infection may not be good candidates for antiviral therapy. –The Editors

 

Author and Article Information

From MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio.

Acknowledgment: The authors thank Diane Bringman, RN, BSN, Clinical Research Projects Coordinator, for assistance in the project.

Requests for Single Reprints: Arthur J. McCullough, MD, Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109-1998; e-mail, ajm3{at}po.cwru.edu.

Current Author Addresses: Dr. Falck-Ytter: German Cochrane Institute, Stefan-Meier-Strasse 26, 79104 Freiburg, Germany.

Drs. Kale, Mullen, Sarbah, Sorescu, and McCullough: MetroHealth Medical Center, Department of Medicine, Division of Gastroenterology, 2500 MetroHealth Drive, Cleveland, OH 44109-1998.

Author Contributions: Conception and design: Y. Falck-Ytter, K.D. Mullen, A.J. McCullough.

Analysis and interpretation of the data: Y. Falck-Ytter, H. Kale, A.J. McCullough.

Drafting of the article: Y. Falck-Ytter, K.D. Mullen, A.J. McCullough.

Critical revision of the article for important intellectual content: K.D. Mullen, A.J. McCullough.

Final approval of the article: K.D. Mullen.

Provision of study materials or patients: K.D. Mullen, A.J. McCullough.

Administrative, technical, or logistic support: Y. Falck-Ytter, H. Kale.

Collection and assembly of data: Y. Falck-Ytter, S.A. Sarbah, L. Sorescu.

Related articles in Annals:

Summaries for Patients
Who Gets Antiviral Treatment for Hepatitis C?

Annals 2002 136: I48. [Full Text]  

Letters
Use of Antiviral Therapy in Patients with Hepatitis C
Catherine Diamond AND Jea Hyun Lee

Annals 2002 137: 1012. [Full Text]  

Letters
Prevention of Hepatocellular Carcinoma
Hashem B. El-Serag

Annals 2004 141: 77-78. [Full Text]  

This article has been cited by other articles:

				E. Dieperink, J. Leskela, M. E. Dieperink, B. Evans, P. Thuras, and S. B. Ho The Effect of Pegylated Interferon-{alpha}2b and Ribavirin on Posttraumatic Stress Disorder Symptoms Psychosomatics, May 1, 2008; 49(3): 225 - 229. [Abstract] [Full Text] [PDF]

				C. M. Rousseau, G. N. Ioannou, J. A. Todd-Stenberg, K. L. Sloan, M. F. Larson, C. W. Forsberg, and J. A. Dominitz Racial Differences in the Evaluation and Treatment of Hepatitis C Among Veterans: A Retrospective Cohort Study Am J Public Health, May 1, 2008; 98(5): 846 - 852. [Abstract] [Full Text] [PDF]

				B. R. Schackman, P. A. Teixeira, G. Weitzman, A. I. Mushlin, and I. M. Jacobson Quality-of-Life Tradeoffs for Hepatitis C Treatment: Do Patients and Providers Agree? Med Decis Making, April 1, 2008; 28(2): 233 - 242. [Abstract] [PDF]

				M. A. Rifai, J. K. Moles, and D. D. Short Hepatitis C Treatment Eligibility and Outcomes Among Patients With Psychiatric Illness Psychiatr Serv, April 1, 2006; 57(4): 570 - 572. [Abstract] [Full Text] [PDF]

				M. A. Rifai, J. K. Moles, L. P. Lehman, and B. J. Van der Linden Hepatitis C screening and treatment outcomes in patients with substance use/dependence disorders. Psychosomatics, March 1, 2006; 47(2): 112 - 121. [Abstract] [Full Text] [PDF]

				C. A Hughes and S. D Shafran Treatment of Hepatitis C in HIV-Coinfected Patients Ann. Pharmacother., March 1, 2006; 40(3): 479 - 489. [Abstract] [Full Text] [PDF]

				P. L. Santaguida, M. Helfand, and P. Raina Challenges in Systematic Reviews That Evaluate Drug Efficacy or Effectiveness Ann Intern Med, June 21, 2005; 142(12_Part_2): 1066 - 1072. [Abstract] [Full Text] [PDF]

				H. Barth, A. Ulsenheimer, G. R. Pape, H. M. Diepolder, M. Hoffmann, C. Neumann-Haefelin, R. Thimme, P. Henneke, R. Klein, G. Paranhos-Baccala, et al. Uptake and presentation of hepatitis C virus-like particles by human dendritic cells Blood, May 1, 2005; 105(9): 3605 - 3614. [Abstract] [Full Text] [PDF]

				B. I. Hernandez-Santiago, T. Beltran, L. Stuyver, C. K. Chu, and R. F. Schinazi Metabolism of the Anti-Hepatitis C Virus Nucleoside {beta}-D-N4-Hydroxycytidine in Different Liver Cells Antimicrob. Agents Chemother., December 1, 2004; 48(12): 4636 - 4642. [Abstract] [Full Text] [PDF]

				J. D. Matthews and E. J. Bini Epidemiology, Diagnosis, and Treatment of Chronic Hepatitis C Journal of Pharmacy Practice, August 1, 2004; 17(4): 229 - 238. [Abstract] [PDF]

				H. B. El-Serag Prevention of Hepatocellular Carcinoma Ann Intern Med, July 6, 2004; 141(1): 77 - 78. [Full Text] [PDF]

				R. Chou, E. C. Clark, and M. Helfand Screening for Hepatitis C Virus Infection: A Review of the Evidence for the U.S. Preventive Services Task Force Ann Intern Med, March 16, 2004; 140(6): 465 - 479. [Abstract] [Full Text] [PDF]

				L. G. Rocca, B. P. Yawn, P. Wollan, and W. R. Kim Management of Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and Decisions to Treat Ann. Fam. Med, March 1, 2004; 2(2): 116 - 124. [Abstract] [Full Text] [PDF]

				R. L. Koretz Update in Gastroenterology Ann Intern Med, September 2, 2003; 139(5_Part_1): 352 - 358. [Full Text] [PDF]

				S. A. Allen, A. C. Spaulding, A. M. Osei, L. E. Taylor, A. M. Cabral, and J. D. Rich Treatment of Chronic Hepatitis C in a State Correctional Facility Ann Intern Med, February 4, 2003; 138(3): 187 - 190. [Abstract] [Full Text] [PDF]

				T. M. Hammett Adopting More Systematic Approaches to Hepatitis C Treatment in Correctional Facilities Ann Intern Med, February 4, 2003; 138(3): 235 - 236. [Full Text] [PDF]

				C. Diamond and J. H. Lee Use of Antiviral Therapy in Patients with Hepatitis C Ann Intern Med, December 17, 2002; 137(12): 1012 - 1012. [Full Text] [PDF]

				S. K. Herrine Approach to the Patient with Chronic Hepatitis C Virus Infection Ann Intern Med, May 21, 2002; 136(10): 747 - 757. [Abstract] [Full Text] [PDF]

				Hepatitis C: Few Candidates for Modestly Effective Treatment Journal Watch Pediatrics and Adolescent Medicine, May 13, 2002; 2002(513): 12 - 12. [Full Text]

				Hepatitis C: Few Candidates for Modestly Effective Treatment Journal Watch (General), March 5, 2002; 2002(305): 1 - 1. [Full Text]