Hepatitis C
Treatment Patterns in Patients with and without Psychiatric and/or Substance Use
Disorders
Hepatitis
C virus (HCV) infection is more frequent in veterans than in non veterans. Up
to 85% of HCV-infected veterans have psychiatric and/or substance
use (SU) co-morbidities which,
prior to the 2002 NIH Consensus Conference, were considered relative contraindications
to antiviral therapy, assuming a poor adherence. With the objective of evaluating the validity of this assumption,
researchers compared eligibility, completion and response to antiviral therapy
in HCV-infected veterans with and without these comorbidities. Veterans who were anti-HCV-positive and had been seen at least
once in the liver clinic (between October 1999 and June 2002) were identified
through the CT-VAHCS database. Records were reviewed for patient demographics and status of
liver
disease, assessment of treatment
eligibility, type of therapy, completion of therapy and virological response.
Patients with active mental illness (MI) or SU were compared
with those without these comorbidities (controls). Results
Of 697 anti-HCV-positive-patients, 647 HCV-RNA-positive
patients were included, 294 with MI/SA and 353 controls.
Patient demographics, viral and liver disease characteristics
were comparable between groups.
Patients with MI/SA were considered ineligible
for therapy more frequently (53%vs 39%, P < 0.001)
and were treated less frequently (21%vs 28%, P = 0.03)
than controls.
However, completion of therapy (72%vs 59%)
and sustained virological
response (SVR) (20% vs 25%) did not differ significantly
between groups. Based on these findings, the study authors conclude, “HCV-infected
veterans with MI/SA are being offered therapy and treated less often than those
without such co-morbidities. However, therapy completion and SVR rates are similar,
challenging the perception that adherence is poorer in this patient population.” Section of Digestive
Diseases, Department of Internal Medicine, Yale University School of Medicine
and Yale New Haven Hospital, New Haven; Hepatitis C Resource Center, VA CT Healthcare
System, West Haven; VA CT Healthcare System, West Haven; and Department of Psychiatry,
Yale University School of Medicine and Yale New Haven Hospital, New Haven, CT,
USA. 4/11/06 Reference
S Chainuvati, S K Khalid, S Kancir
and others. Comparison of hepatitis C treatment patterns in patients with
and without psychiatric and/or substance use disorders. Journal of Viral Hepatitis 13(4): 235-241.
April 2006.
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