Hepatitis C infection:: eligibility for antiviral therapies
Hepatitis C infection:: eligibility for antiviral therapies
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DOI：
10.1097/00042737-200511000-00006
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发表时间：
2005-11-01
影响因子：
2.1
通讯作者：
Belaïche, J
中科院分区：
文献类型：
--
作者：
Delwaide, J;El Saouda, R;Belaïche, J
背景 目前慢性丙型肝炎病毒 (HCV) 的治疗是有效的，但昂贵且容易引起明显的副作用。目的 评估适合接受治疗的 HCV 患者的比例。方法 在包含 1726 名病毒血症 HCV 患者的数据库中，对 1996 年至 2003 年间向同一肝病专家初次预约的 299 名患者的档案进行审查。结果 患者特征为年龄 43.1 +/- 15.6 岁， 53% 为男性，92% 为白种人。主要危险因素是输血（43%）和吸毒（22%）。基因型主要为基因型1（66%）、基因型3（12%）和基因型2（10%）。这些特征与整个系列的 1726 名患者没有什么不同。共有 176 名患者（59%）未接受治疗，未治疗的原因是医疗禁忌症（34%）、不遵守规定（25%）和转氨酶正常（24%）。此外，尽管被认为符合条件，但仍有 17% 的患者拒绝接受治疗，这主要是由于担心不良事件。医疗禁忌症包括精神疾病（27%）、年龄（22%）、终末期肝病（15%）、怀孕意愿（13%）、心脏禁忌症（7%）和其他（16%）。只有 123 名患者 (41%) 接受了治疗。 41% 的人观察到持续的病毒反应。 16% 的患者因不良事件而中断治疗。 结论 大多数 HCV 患者不符合治疗条件。这意味着，在目前的治疗下，只有 17% 的慢性 HCV 患者成为持续缓解者。对指南的一些修改可以提高治疗率（转氨酶正常的患者），但一个重要的障碍仍然是患者和医生对不良事件的恐惧。
Background Current treatments of chronic hepatitis C virus (HCV) are effective, but expensive and susceptible to induce significant side effects.Objectives To evaluate the proportion of HCV patients who are eligible for a treatment.Methods In a database comprising 1726 viraemic HCV patients, the files of 299 patients who presented to the same hepatologist for an initial appointment between 1996 and 2003 were reviewed.Results Patients' characteristics were age 43.1 +/- 15.6 years, 53% male and 92% Caucasian. The main risk factors were transfusion (43%) and drug use (22%). Genotypes were mostly genotype 1 (66%), genotype 3 (12%) and genotype 2 (10%). These characteristics were not different from those of the whole series of 1726 patients. A total of 176 patients (59%) were not treated, the reasons for non-treatment being medical contraindications (34%), non-compliance (25%) and normal transaminases (24%). In addition, 17% of patients declined therapy despite being considered as eligible, mainly due to fear of adverse events. Medical contraindications were psychiatric (27%), age (22%), end-stage liver disease (15%), willingness for pregnancy (13%), cardiac contraindication (7%) and others (16%). Only 123 patients (41%) were treated. A sustained viral response was observed in 41%. The treatment was interrupted in 16% for adverse events.Conclusions The majority of HCV patients are not eligible for treatment. This implies that, with current therapies, only 17% of patients referred for chronic HCV become sustained responders. Some modifications of guidelines could extend the rate of treatment (patients with normal transaminases), but an important barrier remains the patients' and the doctors' fear of adverse events.