Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection

Edmund J. Bini, Norbert Bräu, Sue Currie, Hui Shen, Bhupinderjit S. Anand, Ke Qin Hu, Lennox Jeffers, Samuel B. Ho, David Johnson, Warren N. Schmidt, Paul King, Ramsey Cheung, Timothy R. Morgan, Joseph Awad, Marcos Pedrosa, Kyong Mi Chang, Ayse Aytaman, Franz Simon, Curt Hagedorn, Richard Moseley & 7 others Jawad Ahmad, Charles Mendenhall, Bradford Waters, Doris Strader, Anna W. Sasaki, Stephen Rossi, Teresa L. Wright

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1772-1779
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume100
Issue number8
DOIs
StatePublished - Aug 1 2005

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Veterans
Chronic Hepatitis C
Virus Diseases
Hepacivirus
Multicenter Studies
Antiviral Agents
Prospective Studies
Therapeutics
Substance-Related Disorders
Psychiatry
Ribavirin
Sexual Partners
Interferon-alpha
Liver Diseases

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection. / Bini, Edmund J.; Bräu, Norbert; Currie, Sue; Shen, Hui; Anand, Bhupinderjit S.; Hu, Ke Qin; Jeffers, Lennox; Ho, Samuel B.; Johnson, David; Schmidt, Warren N.; King, Paul; Cheung, Ramsey; Morgan, Timothy R.; Awad, Joseph; Pedrosa, Marcos; Chang, Kyong Mi; Aytaman, Ayse; Simon, Franz; Hagedorn, Curt; Moseley, Richard; Ahmad, Jawad; Mendenhall, Charles; Waters, Bradford; Strader, Doris; Sasaki, Anna W.; Rossi, Stephen; Wright, Teresa L.

In: American Journal of Gastroenterology, Vol. 100, No. 8, 01.08.2005, p. 1772-1779.

Research output: Contribution to journalArticle

Bini, EJ, Bräu, N, Currie, S, Shen, H, Anand, BS, Hu, KQ, Jeffers, L, Ho, SB, Johnson, D, Schmidt, WN, King, P, Cheung, R, Morgan, TR, Awad, J, Pedrosa, M, Chang, KM, Aytaman, A, Simon, F, Hagedorn, C, Moseley, R, Ahmad, J, Mendenhall, C, Waters, B, Strader, D, Sasaki, AW, Rossi, S & Wright, TL 2005, 'Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection', American Journal of Gastroenterology, vol. 100, no. 8, pp. 1772-1779. https://doi.org/10.1111/j.1572-0241.2005.41860.x
Bini, Edmund J. ; Bräu, Norbert ; Currie, Sue ; Shen, Hui ; Anand, Bhupinderjit S. ; Hu, Ke Qin ; Jeffers, Lennox ; Ho, Samuel B. ; Johnson, David ; Schmidt, Warren N. ; King, Paul ; Cheung, Ramsey ; Morgan, Timothy R. ; Awad, Joseph ; Pedrosa, Marcos ; Chang, Kyong Mi ; Aytaman, Ayse ; Simon, Franz ; Hagedorn, Curt ; Moseley, Richard ; Ahmad, Jawad ; Mendenhall, Charles ; Waters, Bradford ; Strader, Doris ; Sasaki, Anna W. ; Rossi, Stephen ; Wright, Teresa L. / Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection. In: American Journal of Gastroenterology. 2005 ; Vol. 100, No. 8. pp. 1772-1779.
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abstract = "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.",
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T1 - Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection

AU - Bini, Edmund J.

AU - Bräu, Norbert

AU - Currie, Sue

AU - Shen, Hui

AU - Anand, Bhupinderjit S.

AU - Hu, Ke Qin

AU - Jeffers, Lennox

AU - Ho, Samuel B.

AU - Johnson, David

AU - Schmidt, Warren N.

AU - King, Paul

AU - Cheung, Ramsey

AU - Morgan, Timothy R.

AU - Awad, Joseph

AU - Pedrosa, Marcos

AU - Chang, Kyong Mi

AU - Aytaman, Ayse

AU - Simon, Franz

AU - Hagedorn, Curt

AU - Moseley, Richard

AU - Ahmad, Jawad

AU - Mendenhall, Charles

AU - Waters, Bradford

AU - Strader, Doris

AU - Sasaki, Anna W.

AU - Rossi, Stephen

AU - Wright, Teresa L.

PY - 2005/8/1

Y1 - 2005/8/1

N2 - 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.

AB - 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.

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