Chainuvati S, Khalid S K, Kancir S, Shea M, Edwards J, Sernyak M, Wongcharatrawee S, Garcia-Tsao G
Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine and Yale New Haven Hospital, CT 06516, USA.
J Viral Hepat. 2006 Apr;13(4):235-41. doi: 10.1111/j.1365-2893.2005.00681.x.
Hepatitis C virus (HCV) infection is more frequent in veterans than in nonveterans. 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, we 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). 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. 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.
丙型肝炎病毒（HCV）感染在退伍军人中比在非退伍军人中更为常见。高达85%的HCV感染退伍军人患有精神疾病和/或物质使用（SU）共病，在2002年美国国立卫生研究院共识会议之前，这些共病被认为是抗病毒治疗的相对禁忌证，因为假定依从性较差。为了评估这一假设的有效性，我们比较了有和没有这些共病的HCV感染退伍军人在抗病毒治疗的资格、完成情况和反应方面的差异。通过CT-VAHCS数据库识别出抗HCV阳性且在肝脏诊所至少就诊过一次（1999年10月至2002年6月期间）的退伍军人。查阅记录以了解患者人口统计学和肝病状况、治疗资格评估、治疗类型、治疗完成情况和病毒学反应。将患有活动性精神疾病（MI）或SU的患者与没有这些共病的患者（对照组）进行比较。在697例抗HCV阳性患者中，纳入了647例HCV-RNA阳性患者，其中294例患有MI/SU，353例为对照组。两组之间的患者人口统计学、病毒和肝病特征具有可比性。与对照组相比，患有MI/SU的患者被认为更频繁地不符合治疗资格（53%对39%，P<0.001）且接受治疗的频率更低（21%对28%，P=0.03）。然而，两组之间的治疗完成率（72%对59%）和持续病毒学应答（SVR）（20%对25%）没有显著差异。患有MI/SU的HCV感染退伍军人比没有此类共病的退伍军人接受治疗的机会更少，但治疗完成率和SVR率相似，这对认为该患者群体依从性较差的观念提出了挑战。
