Limited success of HCV antiviral therapy in United States veterans
Limited success of HCV antiviral therapy in United States veterans
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DOI：
10.1111/j.1572-0241.2002.05439.x
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发表时间：
2002-01-01
影响因子：
9.8
通讯作者：
Fimmel, CJ
中科院分区：
文献类型：
--
作者：
Cawthorne, CH;Rudat, KR;Fimmel, CJ
目的：治疗丙型肝炎病毒（HCV）感染的美国退伍军人已成为退伍军人管理局医疗保健系统的一项主要任务。尽管HCV感染患者的综合诊断和治疗已被强制要求，但对HCV诊所的性能特征以及抗病毒治疗在这一独特患者人群中的结果知之甚少。方法：我们回顾性研究了大型城市退伍军人事务部医疗中心专门的HCV门诊的诊所显示率，治疗资格和抗病毒治疗的反应。结果：我们的数据表明，很少有退伍军人，无论他们的年龄或种族背景，追求评估和治疗他们的丙型肝炎病毒感染的肝病学家。接受综合临床评估的少数患者符合抗病毒治疗的标准资格标准。抗病毒治疗的总体疗效，如持续病毒学应答率所衡量的，大大低于先前在随机临床试验中报道的。HCV感染的退伍军人的特点是一个独特的风险因素的组合，是预测一个不良反应的抗病毒治疗，包括男性占优势，HCV基因型I，年龄> 40岁，和组织学先进程度的肝脏疾病。我们的研究表明，在美国退伍军人人群中，门诊HCV治疗计划的局限性，这表明目前HCV治疗计划的总体影响可能很小。(C)2002年，我胃肠病学。
OBJECTIVE: The treatment of hepatitis C virus (HCV) infection in United States veterans has become a major task for the Veterans Administration Healthcare System. Although the comprehensive diagnosis and treatment of HCV-infected patients has been mandated, little is known about the performance characteristics of HCV clinics and about the outcomes of antiviral therapy in this unique patient population.METHODS: We retrospectively examined clinic show rates, treatment eligibility, and the response to antiviral therapy in a dedicated HCV outpatient clinic in a large urban Veterans Affairs medical center.RESULTS: Our data demonstrate that few veterans-regardless of their age or ethnic background-pursue evaluation and treatment of their HCV infection by hepatologists. A minority of those patients who undergo a comprehensive clinic evaluation meet the standard eligibility criteria for antiviral therapy. The overall efficacy of antiviral treatment, as measured by the sustained virological response rate, is substantially lower than previously reported in randomized clinical trials. HCV-infected veterans are characterized by a unique combination of risk factors that are predictive of a poor response to antiviral therapy, including a preponderance of male gender, HCV genotype I, age > 40 yr, and histologically advanced degrees of liver disease.CONCLUSIONS: Our study demonstrates the limitations of outpatient HCV treatment initiatives in the United States veteran population, and suggests that the overall impact of current HCV treatment programs may be small. (C) 2002 by Am. Coll. of Gastroenterology.