Cawthorne Cathey H, Rudat Kelly R, Burton Mary S, Brown Kyle E, Luxon Bruce A, Janney Christine G, Fimmel Claus J
St. Louis VA Medical Center, Missouri, USA.
Am J Gastroenterol. 2002 Jan;97(1):149-55. doi: 10.1111/j.1572-0241.2002.05439.x.
The treatment of hepatitis C virus (HCV) infection in United States veterans has become a major task for the Veterans Administration Healthcare System. Although the comprehensive diagnosis and treatment of HCV-infected patients has been mandated, little is known about the performance characteristics of HCV clinics and about the outcomes of antiviral therapy in this unique patient population.
We retrospectively examined clinic show rates, treatment eligibility, and the response to antiviral therapy in a dedicated HCV outpatient clinic in a large urban Veterans Affairs medical center.
Our data demonstrate that few veterans--regardless of their age or ethnic background--pursue evaluation and treatment of their HCV infection by hepatologists. A minority of those patients who undergo a comprehensive clinic evaluation meet the standard eligibility criteria for antiviral therapy. The overall efficacy of antiviral treatment, as measured by the sustained virological response rate, is substantially lower than previously reported in randomized clinical trials. HCV-infected veterans are characterized by a unique combination of risk factors that are predictive of a poor response to antiviral therapy, including a preponderance of male gender, HCV genotype I, age > 40 yr, and histologically advanced degrees of liver disease.
Our study demonstrates the limitations of outpatient HCV treatment initiatives in the United States veteran population, and suggests that the overall impact of current HCV treatment programs may be small.
美国退伍军人丙型肝炎病毒（HCV）感染的治疗已成为退伍军人事务部医疗系统的一项主要任务。尽管已要求对HCV感染患者进行全面诊断和治疗，但对于HCV诊所的工作特点以及这一特殊患者群体的抗病毒治疗结果却知之甚少。
我们回顾性研究了一家大型城市退伍军人事务医疗中心专门的HCV门诊诊所的就诊率、治疗资格以及对抗病毒治疗的反应。
我们的数据表明，很少有退伍军人——无论其年龄或种族背景如何——寻求肝病专家对其HCV感染进行评估和治疗。接受全面门诊评估的患者中，少数符合抗病毒治疗的标准资格标准。以持续病毒学应答率衡量的抗病毒治疗总体疗效显著低于先前随机临床试验报告的结果。HCV感染的退伍军人具有一系列独特的危险因素组合，这些因素可预测对抗病毒治疗反应不佳，包括男性占比高、HCV基因1型、年龄>40岁以及组织学上肝病进展程度高。
我们的研究证明了美国退伍军人人群门诊HCV治疗举措的局限性，并表明当前HCV治疗项目的总体影响可能较小。
