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Management of chronic hepatitis C: clinical audit of biopsy based management algorithm
G R Foster1, R D Goldin, J Main
1Liver Unit, Imperial College School of Medicine at St Mary's, London.
Insights
Many patients with chronic hepatitis C avoid further investigation and treatment, with low interferon alfa response rates (21%). Patients with cirrhosis face a high risk of hepatocellular carcinoma, necessitating new management strategies.
Area of Science:
- Hepatology and Viral Hepatitis Research
- Clinical Gastroenterology
- Oncology and Carcinogenesis
Background:
- Chronic hepatitis C infection poses significant public health challenges.
- Understanding patient adherence to diagnostic and treatment protocols is crucial for effective management.
- Hepatocellular carcinoma is a major complication in patients with hepatitis C-related cirrhosis.
Purpose of the Study:
- To evaluate patient attendance, treatment compliance, and outcomes in chronic hepatitis C management.
- To assess the efficacy of interferon alfa treatment based on a biopsy-driven algorithm.
- To identify challenges in current strategies for investigating and treating chronic hepatitis C.
Main Methods:
- Retrospective audit of 255 patients with chronic hepatitis C attending a London teaching hospital's liver unit.
- Analysis of patient survival, attendance, and compliance with diagnostic and therapeutic regimens.
- Interferon alfa treatment response was determined by loss of viraemia three months post-treatment.
Main Results:
- A substantial number of patients (39%) declined further investigation after diagnosis.
- Among those seeking treatment, 42% with severe hepatic fibrosis opted out of available therapies.
- Interferon alfa yielded a 21% response rate, comparable to trial settings, with no significant difference based on fibrosis severity (excluding cirrhosis).
- Patients with cirrhosis experienced an 18% incidence of hepatocellular carcinoma over 20 months.
Conclusions:
- Current approaches to investigating and treating chronic hepatitis C are not widely accepted by patients.
- Hepatitis C-related cirrhosis is associated with a high risk of developing hepatic neoplasms.
- Urgent development of improved management strategies for hepatitis C patients, particularly those with cirrhosis, is required.
Objective:
To assess the attendance, outcome, compliance with treatment, and response to interferon alfa in patients with chronic hepatitis C who attended during 1995 and were treated according to a biopsy based algorithm.
Design:
Retrospective audit of all patients with chronic hepatitis C attending outpatient clinics over one year.
Setting:
The liver unit at a London teaching hospital.
Subjects:
255 patients with chronic hepatitis C.
Main Outcome Measures:
Patient survival, attendance, and compliance with diagnostic and therapeutic regimens. Response to interferon alfa treatment, based on loss of viraemia three months after cessation of treatment.
Results:
A large proportion of patients (39%) with newly diagnosed chronic hepatitis C infection do not want to undergo further investigation. Of those patients who do attend for further treatment, a large proportion with severe hepatic fibrosis (42%) do not want to undergo currently available treatment. The response rate to interferon (21%) in treated patients was similar to that previously reported in a trial setting. There was no significant difference in response rates in patients with or without severe fibrosis not amounting to cirrhosis. In patients with cirrhosis there was a high incidence of hepatocellular carcinoma (18%) over a follow up period of 20 months.
Conclusion:
Current strategies aimed at investigating and treating patients with chronic hepatitis C are not acceptable to a large proportion of patients. Many patients with cirrhosis related to hepatitis C infection develop hepatic neoplasms, and management strategies to deal with this problem are urgently required.