Skip to main content

Advertisement

SpringerLink
Log in

Rate and Factors Affecting Treatment Uptake of Patients with Chronic Hepatitis C in a Tertiary Referral Hospital

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Contraindications to interferon and ribavirin for treatment of chronic hepatitis C (CHC) are well recognized, and previous data indicated the consequent suboptimal treatment uptake.

Aim

To evaluate the treatment rate of CHC patients in a tertiary referral center in Hong Kong, and to examine the reasons for non-treatment.

Methods

A retrospective review of all referred CHC patients to the outpatient clinic was conducted. Treatment uptake rate was evaluated and patients’ sociodemographic, biochemical, and histological data were examined to identify reasons for treatment decision.

Results

CHC patients (303) were assessed for antiviral therapy from 2000 to 2009. Of the patients, 138 (45.5%) did not receive antiviral therapy. Reasons for non-treatment were as follows: 31.9% declined treatment, 18.8% had decompensated cirrhosis, 12.3% were considered too elderly, 17.4% had too mild liver disease, 7.2% had psychiatric history, 7.2% had significant comorbidities, and 2.9% had ongoing alcohol or substance abuse. Independent factors associated with non-treatment were older age (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.03–1.08, p < 0.001), significant comorbidities (aOR 2.53, 95% CI 1.34–4.78, p = 0.004), psychiatric history (aOR 6.04, 95% CI 2.14–17.02, p < 0.001), mild liver disease (aOR 7.72, 95% CI 3.86–15.44, p < 0.001) and decompensated cirrhosis (aOR 9.42, 95% CI 2.57–34.50, p < 0.001).

Conclusions

Current treatment uptake for CHC patients was suboptimal, as a large proportion of patients were either reluctant for treatment or not suitable for the current antiviral therapy. Multidisciplinary interventions are needed in the short term while alternative antiviral therapy is desired in the long term to overcome barriers to treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Poynard T, Yuen MF, Ratziu V, Lai CL. Viral hepatitis C. Lancet. 2003;362(9401):2095–2100.

    Article  CAS  PubMed  Google Scholar 

  2. Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 2005;5(9):558–567.

    Article  PubMed  Google Scholar 

  3. Leung N, Chu C, Tam JS. Viral hepatitis C in Hong Kong. Intervirology. 2006;49(1–2):23–27.

    Article  PubMed  Google Scholar 

  4. Volk ML, Tocco R, Saini S, Lok AS. Public health impact of antiviral therapy for hepatitis C in the United States. Hepatology. 2009;50(6):1750–1755.

    Article  PubMed  Google Scholar 

  5. Wise M, Bialek S, Finelli L, Bell BP, Sorvillo F. Changing trends in hepatitis C-related mortality in the United States, 1995–2004. Hepatology. 2008;47(4):1128–1135.

    Article  PubMed  Google Scholar 

  6. Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial. Lancet. 2001;358(9286):958–965.

    Article  CAS  PubMed  Google Scholar 

  7. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002;347(13):975–982.

    Article  CAS  PubMed  Google Scholar 

  8. Sroczynski G, Esteban E, Conrads-Frank A, et al. Long-term effectiveness and cost-effectiveness of antiviral treatment in hepatitis C. J Viral Hepat. 2010;17(1):34–50.

    Article  CAS  PubMed  Google Scholar 

  9. George SL, Bacon BR, Brunt EM, et al. Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: A 5-year follow-up of 150 patients. Hepatology. 2009;49(3):729–738.

    Article  CAS  PubMed  Google Scholar 

  10. McHutchison JG, Everson GT, Gordon SC, et al. Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. N Engl J Med. 2009;360(18):1827–1838.

    Article  CAS  PubMed  Google Scholar 

  11. McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis interventional therapy group. N Engl J Med. 1998;339(21):1485–1492.

    Article  CAS  PubMed  Google Scholar 

  12. Falck-Ytter Y, Kale H, Mullen KD, et al. Surprisingly small effect of antiviral treatment in patients with hepatitis C. Ann Intern Med. 2002;136(4):288–292.

    CAS  PubMed  Google Scholar 

  13. Moirand R, Bilodeau M, Brissette S, Bruneau J. Determinants of antiviral treatment initiation in a hepatitis C-infected population benefiting from universal health care coverage. Can J Gastroenterol. 2007;21(6):355–361.

    PubMed  Google Scholar 

  14. Butt AA, Justice AC, Skanderson M, et al. Rate and predictors of treatment prescription for hepatitis C. Gut. 2007;56(3):385–389.

    Article  PubMed  Google Scholar 

  15. Kanwal F, Hoang T, Spiegel BM, et al. Predictors of treatment in patients with chronic hepatitis C infection—Role of patient versus nonpatient factors. Hepatology. 2007;46(6):1741–1749.

    Article  CAS  PubMed  Google Scholar 

  16. Yan KK, Guirgis M, Dinh T, et al. Treatment responses in Asians and Caucasians with chronic hepatitis C infection. World J Gastroenterol. 2008;14(21):3416–3420.

    Article  PubMed  Google Scholar 

  17. Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: An update. Hepatology. 2009;49(4):1335–1374.

    Article  CAS  PubMed  Google Scholar 

  18. McCaughan GW, Omata M, Amarapurkar D, et al. Asian Pacific Association for the study of the liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection. J Gastroenterol Hepatol. 2007;22(5):615–633.

    Article  CAS  PubMed  Google Scholar 

  19. Cawthorne CH, Rudat KR, Burton MS, et al. Limited success of HCV antiviral therapy in United States veterans. Am J Gastroenterol. 2002;97(1):149–155.

    Article  PubMed  Google Scholar 

  20. Roberts SK, Weltman MD, Crawford DH, et al. Impact of high-dose peginterferon alfa-2A on virological response rates in patients with hepatitis C genotype 1: A randomized controlled trial. Hepatology. 2009;50(4):1045–1055.

    Article  CAS  PubMed  Google Scholar 

  21. Wong JB, Koff RS. Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis. Ann Intern Med. 2000;133(9):665–675.

    CAS  PubMed  Google Scholar 

  22. Deuffic-Burban S, Babany G, Lonjon-Domanec I, et al. Impact of pegylated interferon and ribavirin on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France. Hepatology. 2009;50(5):1351–1359.

    Article  CAS  PubMed  Google Scholar 

  23. Iwasaki Y, Ikeda H, Araki Y, et al. Limitation of combination therapy of interferon and ribavirin for older patients with chronic hepatitis C. Hepatology. 2006;43(1):54–63.

    Article  CAS  PubMed  Google Scholar 

  24. Koyama R, Arase Y, Ikeda K, et al. Efficacy of interferon therapy in elderly patients with chronic hepatitis C. Intervirology. 2006;49(3):121–126.

    Article  CAS  PubMed  Google Scholar 

  25. Huang CF, Yang JF, Dai CY, et al. Efficacy and safety of pegylated interferon combined with ribavirin for the treatment of older patients with chronic hepatitis C. J Infect Dis. 2010;201(5):751–759.

    Article  CAS  PubMed  Google Scholar 

  26. Antonucci G, Longo MA, Angeletti C, et al. The effect of age on response to therapy with peginterferon alpha plus ribavirin in a cohort of patients with chronic HCV hepatitis including subjects older than 65 yr. Am J Gastroenterol. 2007;102(7):1383–1391.

    Article  CAS  PubMed  Google Scholar 

  27. Arase Y, Ikeda K, Suzuki F, et al. Long-term outcome after interferon therapy in elderly patients with chronic hepatitis C. Intervirology. 2007;50(1):16–23.

    Article  CAS  PubMed  Google Scholar 

  28. Huang JF, Yu ML, Lee CM, et al. Sustained virological response to interferon reduces cirrhosis in chronic hepatitis C: A 1,386-patient study from Taiwan. Aliment Pharmacol Ther. 2007;25(9):1029–1037.

    Article  CAS  PubMed  Google Scholar 

  29. Khokhar OS, Lewis JH. Reasons why patients infected with chronic hepatitis C virus choose to defer treatment: do they alter their decision with time? Dig Dis Sci. 2007;52(5):1168–1176.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China

    Kenneth Kar-Lung Yan, Grace Lai-Hung Wong, Vincent Wai-Sun Wong & Henry Lik-Yuen Chan

  2. Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China

    Henry Lik-Yuen Chan

Authors
  1. Kenneth Kar-Lung Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Grace Lai-Hung Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincent Wai-Sun Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henry Lik-Yuen Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry Lik-Yuen Chan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yan, K.KL., Wong, G.LH., Wong, V.WS. et al. Rate and Factors Affecting Treatment Uptake of Patients with Chronic Hepatitis C in a Tertiary Referral Hospital. Dig Dis Sci 55, 3541–3547 (2010). https://doi.org/10.1007/s10620-010-1412-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1412-1

Keywords

Search

Navigation