Surprisingly Small Effect of Antiviral Treatment in Patients with Hepatitis C

  1. Yngve Falck-Ytter, MD;
  2. Hemangi Kale, MD;
  3. Kevin D. Mullen, MD;
  4. Steedman A. Sarbah, MD;
  5. Lucian Sorescu, MD; and
  6. Arthur J. McCullough, MD
  1. From MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio.

    Abstract

    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.

    Article and Author Information

    • 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.

    Summary for Patients

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    1. Ann Intern Med February 19, 2002 vol. 136 no. 4 288-292
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