Knowledge About Infection Is the Only Predictor of Treatment in Patients With Chronic Hepatitis C

Z. M. Younossi; M. Stepanova; M. Afendy; B. P. Lam; A. Mishra

Disclosures

J Viral Hepat. 2013;20(8):550-555. 

In This Article

Discussion

This study assesses the follow-up of patients who were identified as having hepatitis C during NHANES screening surveys. Our data suggest that a number of clinical and demographic factors are associated with lack of treatment for hepatitis C. However, after controlling for confounders by multivariate analysis, only previous knowledge of HCV was independently associated with treatment. This data highlight the importance of screening for HCV that could lead to increased knowledge about HCV and potentially result in higher likelihood of receiving appropriate treatment.

Our data also suggest that being male, feeling in excellent health and excessive alcohol consumption are independently associated with lack of knowledge about HCV infection. Again, this is an important finding that highlights the importance of screening in individuals with CH-C who are especially at risk of progressive liver disease and mortality, that is, individuals with HCV infection who excessively drink alcohol. Our data also indicate that access to care and higher income are independent factors associated with awareness of HCV infection and therefore receiving appropriate care. This conundrum highlights the dilemma of HCV infection. The population with the highest prevalence of HCV and the greatest need for appropriate treatment also belong to the lower socioeconomic group with more limited access to care and less likely to become aware of their HCV status. This dilemma should be addressed by health policy makers to widely implement the 'birth cohort' screening strategies for HCV. Additionally, access to appropriate care, including advice against alcohol consumption and anti-viral treatment, must be provided. Without a comprehensive policy to deal with the burden of CH-C, the toll on health, health-related quality of life and the socioeconomic burden of HCV will continue to rise.

The limitation of our study is the lack of direct patient data in the follow-up. Additionally, the relatively small sample size and a short follow-up may have resulted in our inability to show some important association. Nevertheless, the design of the study includes the use of an established database, although, given the low response rate, we could not make population-wide conclusions.

In summary, our data suggest that HCV knowledge of infection is the most important predictor of receiving treatment. This data provide additional support for the recently recommended screening of U.S. Population based on birth cohort.

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