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Yngve T Falck-Ytter, Steedman A Sarbah, Lucian Sorescu, Kevin D Mullen, Arthur J McCullough, MetroHealth Medical Ctr, Cleveland, OH

Background: In the United States, 1.8% of the population have been infected with the Hepatitis C virus (HCV) and up to 10,000 die from HCV related chronic liver disease each year. Current treatment options aimed to eradicate HCV are all Interferon based (+/- Ribavirin). In the past, studies have used highly selected patient groups to determine the sustained response rate of Interferon therapy. However, the potential impact on viral eradication with Interferon therapy in a metropolitan Liver Clinic's Hepatitis C patient population is less well known. Aims: To determine the proportion of patients who qualify for Interferon based therapy and to identify barriers to treatment. Methods: All new patients referred to the Liver Clinic from January 1998 to November 1999 were evaluated retrospectively and the reasons for non-treatment and outcome of treatment were documented. Results: Only 82 patients (25%) of 327 patients evaluated for positive HCV antibody test were started on Interferon based anti-viral therapy. Sustained response was achieved in 6 (7.3%), while 12 patients were still in the post-treatment follow up phase. When these data are combined, an estimated maximum of 18 patients (22%) of the 82 patients treated may clear the virus. This would represent only 6.4% successful viral clearance in all patients evaluated (after excluding patients without viremia (34 patients, 10.4%) and patients currently being worked up (11 patients, 3.4%)). Fifteen patients (18.3%) stopped treatment prematurely because of side effects, 40 (48.8%) were non-responders and 6 (7.3%) relapsed. A total of 200 patients (61.2%) were not treated. Major barriers to treatment included: a) 70 patients (35%) had medical contraindications (depression and other psychiatric disease, decompensated cirrhosis, pregnancy, auto-immune disease etc.); b) 71 patients (35.5%) were non-compliant with evaluation and education (including incarceration and failure to appear for liver biopsy); c) 27 patients (13.5%) had ongoing alcohol and drug use; d) 23 patients (11.5%) refused treatment with Interferon; e) 9 patients (4.5%) had normal ALT. Conclusions: The usefulness of Interferon based treatment of Hepatitis
C is far more limited than usually assumed. In a typical metropolitan Liver Clinic setting, patients seeking care for Hepatitis C will frequently not qualify for Interferon based treatment for a variety of reasons as stated above. Implications: We hypothesize that focusing on improvement of alcohol intervention and treatments strategies based on decreasing hepatic inflammatory activity may have an even greater long-term impact on morbidity and mortality than current anti-viral therapy.


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