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Published on: February 19, 2019
Treatment rates in patients with chronic hepatitis C after liver biopsy
G Narasimhan1, T N Sargios, R Kalakuntla
1Division of Digestive Diseases, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USA.
Insights
Hepatitis C virus (HCV) treatment rates remain low, with only 37% of patients receiving care post-liver biopsy. Common reasons for no treatment include mild disease, lost to follow-up, or patient refusal.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Hepatitis C virus (HCV) infection poses a significant public health challenge in the United States.
- Despite advancements in effective therapies, a low percentage of HCV-infected patients receive treatment.
- Liver biopsy is a diagnostic tool used to assess disease severity and guide treatment decisions.
Purpose of the Study:
- To determine the treatment rate for Hepatitis C virus (HCV) patients following liver biopsy.
- To analyze trends in HCV treatment rates over recent years (1998-2002).
- To identify and delineate the primary reasons for the undertreatment of HCV.
Main Methods:
- Retrospective chart review of HCV patients undergoing liver biopsy at Beth Israel Medical Center between 1998 and 2002.
- Data collection included patient demographics, liver fibrosis stage, insurance status, treatment history, and reasons for non-treatment.
- Statistical analysis, including multivariate analysis, was used to identify predictors of treatment and disease severity.
Main Results:
- Out of 433 HCV patients who underwent liver biopsy, only 159 (37%) received treatment.
- HCV treatment rates remained stable between 1999 and 2002, with no significant changes observed.
- Key reasons for non-treatment were minimal/mild disease (38%), lost to follow-up/noncompliance (31%), and patient refusal (22%).
- Older patients had more comorbidities, while younger age and female gender correlated with minimal disease.
- Patients with Medicaid were more likely to be treated compared to those with private or Medicare-only insurance.
Conclusions:
- A minority of Hepatitis C virus (HCV) infected patients are treated even after liver biopsy, indicating a gap in care.
- HCV treatment rates have remained stagnant despite therapeutic advancements, highlighting persistent challenges in patient management.
- Liver histology often identifies patients with mild disease, leading to a delay or decision against urgent antiviral therapy.
Abstract:
Hepatitis C virus (HCV) infection is a major health problem in the United States. Only about 30% of patients infected with HCV are being treated despite the development of increasingly effective therapies. The aims of this study were to determine the rate of treatment for patients with HCV after undergoing liver biopsy, to assess any change in their treatment rates over recent years and to delineate the reasons for nontreatment. We retrospectively reviewed the charts of all HCV patients who had liver biopsies at Beth Israel Medical Center, New York between 1998 and 2002. The data gathered included patient demographics, stage of liver fibrosis, insurance information, treatment history and reasons for nontreatment. There were 433 liver biopsies done for chronic hepatitis C between 1998 and 2002. Of those, 267 (61%) were men. The mean age was 47 years (range, 18-72). Only 159 (37%) patients were treated after liver biopsy. Overall there were no significant differences in the treatment rates from 1999 to 2002. The common reasons for nontreatment included minimal/mild disease (stage 0-1 fibrosis, 38%), lost to follow-up or noncompliance (31%) and patient refusal (22%). Older patients more frequently had co-morbid conditions (P = 0.009). Younger age and female gender correlated with minimal disease on biopsy (P = 0.004 and 0.01, respectively). Men were lost to follow-up more frequently than women (37%vs 22%, P = 0.01). Multivariate analysis showed that age and gender were both independent predictors of minimal disease. Patients having Medicaid with or without Medicare were significantly more likely to be treated than patients with private or commercial insurance or patients with Medicare alone. A minority of HCV infected patients were treated even after having undergone liver biopsy. The proportion of HCV patients being treated after liver biopsy has been relatively stable despite advances in therapeutic success. Liver histology frequently identified patients with mild disease in whom antiviral therapy was deemed not urgent.
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