HEPACOM: multicenter, observational prospective study of outcome and monitoring of HCV positive antiviral-nalive patients managed in the French health care system
HEPACOM: multicenter, observational prospective study of outcome and monitoring of HCV positive antiviral-nalive patients managed in the French health care system
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DOI：
10.1016/s0399-8320(07)78338-0
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发表时间：
2007-12-01
影响因子：
--
通讯作者：
Roudot-Thoraval, Francoise
中科院分区：
文献类型：
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作者：
Agostini, Helene;Castera, Laurent;Roudot-Thoraval, Francoise
目的 - 研究法国卫生保健系统中未接受过抗病毒治疗的慢性丙型肝炎病毒 (HCV) 感染患者的管理实践。方法和患者 - 两组全科医生，第 I 组（经过特殊培训和吸毒成瘾经验）和第 11 组（其他全科医生）招募了未经治疗的 HCV 阳性患者，并记录了 12 个月的管理实践。结果 - 在 4660 名入组患者中，其中 2038 名由第一组 462 名全科医生入组，保留第 11 组 588 名全科医生中的 1756 名进行分析。这些患者均为成年人，年龄为 42 岁至 14 岁，未接受过抗病毒治疗。男女比例为1：7。 10% 的人同时感染艾滋病毒，12% 的人饮酒过量，61% 的人目前吸毒，其中 75%（占总人口的 45%）正在接受替代疗法。最小的肝脏病变（阶段 = F2）。监测期结束时，64% 的患者被转诊至专科医生处。 20%（即咨询专科医生的患者中的 32%）已开始抗病毒治疗。职业活动 (P < 0.0001)、年轻 (P = 0.007)、较新的诊断 (P < 0.0001)、没有 HIV 合并感染 (P = 0.015)、男性 (P = 0.006)、缺乏替代治疗 (P = 0.006)、既往使用 METAVIR A 和 F 进行的肝脏组织学检查 >= 2 (P < 0.0001）和第一组全科医生入组（P < 0.007）是开始抗病毒治疗的独立预测因素。结论 - 在法国医疗保健系统中只有三分之一的患者开始抗病毒治疗，而某些类别的患者，包括女性、艾滋病毒合并感染患者和接受替代治疗的患者，接受治疗的可能性低于其他患者。在研究期间（2002年）举行的法国共识会议的建议可能已被少数全科医生实施（可能遵循）。
Objective - To study management practices in the French health care system for antiviral-naive patients with chronic hepatitis C virus (HCV) infection.Methods and patients - Two groups of general practitioners, group I (special training and experience in drug addiction) and group 11 (other general practitioners) enrolled untreated HCV positive patients and noted management practices for a 12-month period.Results - Amoung 4660 enrolled patients, 2038 enrolled by 462 general practitioners in group I and 1756 enrolled by 588 general practitioners in group 11 were retained for analysis. These patients were adults, aged 42 14 years, who were naive to antiviral treatment. The male/female ratio was 1:7. Ten percent were coin-fected with HIV, 12% had excessive alcohol intake, and 61% were current drug users, 75% of whom (45% of the total population) were taking replacement therapy. Minimal hepatic lesions (stage = F2). At the end of the monitoring period, 64% of the patients had been referred to a specialist. Antiviral treatment had been started in 20%, i.e. 32% of the patients who consulted a specialist. Occupational activity (P < 0.0001), young age (P = 0.007), more recent diagnosis (P < 0.0001), lack of HIV co-infection (P = 0.015), male gender (P = 0.006), lack of replacement treatment (P = 0.006), previous liver histology with METAVIR A and F >= 2 (P < 0.0001) and enrolment by a group I general practitioner (P < 0.007) were the independent predictive factors of initiation of antiviral treatment.Conclusion - Only one-third of patients with access to the French health care system started antiviral treatment and some categories of patients, including women, patients co-infected with HIV and patients on replacement therapy, were less likely to be treated than others. The recommendations of the French Consensus Conference, held in the middle of the study period (2002), might have been implemented (probably followed) by a minority of general practitioners.