Prospective multicenter study of eligibility for antiviral therapy among 4,084 US veterans with chronic hepatitis C virus infection
Prospective multicenter study of eligibility for antiviral therapy among 4,084 US veterans with chronic hepatitis C virus infection
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DOI：
10.1111/j.1572-0241.2005.41860.x
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发表时间：
2005-08-01
影响因子：
9.8
通讯作者：
Wright, TL
中科院分区：
文献类型：
--
作者：
Bini, EJ;Bräu, N;Wright, TL
背景：由于治疗禁忌症，许多退伍军人可能不是丙型肝炎病毒（HCV）治疗的候选人。本研究的目的是确定HCV感染的退伍军人谁有资格干扰素α和利巴韦林治疗的比例，并评估障碍HCV treatment.METHODS：我们前瞻性地招募了4,084名退伍军人谁被称为HCV治疗超过1年的时间在24退伍军人事务部（VA）医疗中心。治疗候选人进行了评估，使用标准化的标准和治疗clinics.RESULTS的意见：总体而言，32.2%（95%CI，30.8-33.7%）的候选人HCV治疗根据标准化的标准，而40.7%（95%CI，39.2-42.3%）的候选人在治疗临床医生的意见。多变量分析确定了持续的药物滥用（OR = 17.68; 95%CI，12.24-25.53），合并内科疾病（OR = 9.62; 95%CI，6.85-13.50），精神疾病（OR = 9.45; 95%CI，6.70-13.32）和晚期肝病（OR = 8.43; 95%CI，4.42-16.06）作为非治疗候选者的最强预测因子。在被认为是治疗候选者的患者中，76.2%（95%CI，74.0-78.3%）同意接受治疗，多变量分析显示，年龄≥ 50岁的人（OR = 1.37; 95%CI，1.07-1.76）和终身性伴侣> 50人（OR = 1.44; 95%CI，1.08-1.93）更有可能拒绝治疗。大多数退伍军人患者不适合HCV治疗，因为药物滥用，精神疾病和共病医学疾病，许多候选人拒绝治疗。需要多学科合作来克服这一人群中HCV治疗的障碍。
BACKGROUND: Many veterans may not be candidates for hepatitis C virus (HCV) treatment due to contraindications to therapy. The aims of this study were to determine the proportion of HCV-infected veterans who were eligible for interferon alfa and ribavirin therapy and to evaluate barriers to HCV treatment.METHODS: We prospectively enrolled 4,084 veterans who were referred for HCV treatment over a 1-yr period at 24 Veterans Affairs (VA) Medical Centers. Treatment candidacy was assessed using standardized criteria and the opinion of the treating clinician.RESULTS: Overall, 32.2% (95% CI, 30.8-33.7%) were candidates for HCV treatment according to standardized criteria, whereas 40.7% (95% CI, 39.2-42.3%) were candidates in the opinion of the treating clinician. Multivariable analysis identified ongoing substance abuse (OR = 17.68; 95% CI, 12.24-25.53), comorbid medical disease (OR = 9.62; 95% CI, 6.85-13.50), psychiatric disease (OR = 9.45; 95% CI, 6.70-13.32), and advanced liver disease (OR = 8.43; 95% CI, 4.42-16.06) as the strongest predictors of not being a treatment candidate. Among patients who were considered treatment candidates, 76.2% (95% CI, 74.0-78.3%) agreed to be treated and multivariable analysis showed that persons >= 50 yr of age (OR = 1.37; 95% CI, 1.07-1.76) and those with > 50 lifetime sexual partners (OR = 1.44; 95% CI, 1.08-1.93) were more likely to decline treatment.CONCLUSIONS: The majority of veteran patients are not suitable candidates for HCV treatment because of substance abuse, psychiatric disease, and comorbid medical disease, and many who are candidates decline therapy. Multidisciplinary collaboration is needed to overcome barriers to HCV therapy in this population.