Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
J Med Virol. 2016 Feb;88(2):275-81. doi: 10.1002/jmv.24335. Epub 2015 Aug 4.
Under-recognition and under-treatment of chronic hepatitis C virus (HCV) infection is an important determinant of the disease outcome. The aim of this study was to investigate the treatment rate and factor of initiation of interferon-based antiviral treatment for chronic hepatitis C patients in a prospective, multicenter Korean HCV cohort. Treatment-naïve 759 patients with chronic HCV infection were prospectively followed from January 2007-2013 at six university hospitals during a median (interquartile range) follow-up of 769 (76-1,427) days. The subjects consisted of patients with chronic hepatitis C (n = 553, 72.9%), liver cirrhosis (n = 127, 16.7%), and hepatocellular carcinoma (n = 79, 10.4%), and were treated usually using pegylated interferon alpha and ribavirin. Treatment initiation rate and its related factors were analysed. The initiation rate of antiviral treatment was 37.3% (n = 273), and the cumulative probability of treatment initiation over 5 years was 39.4%. Multivariate analysis showed that age <58 years (hazard ratio [HR] = 1.588, 95% CI = 1.151-2.193), job employment (HR = 1.737, 95% CI = 1.279-2.363), absence of HCC (chronic hepatitis, HR = 2.534, 95% CI = 1.003-6.400; liver cirrhosis, HR = 2.873, 95% CI = 1.101-7.494), alanine transaminase (ALT) >40 IU/L (HR = 1.682, 95% CI = 1.228-2.303), and genotype 2 (HR = 1.364, 95% CI = 1.034-1.798) were independent factors related to treatment initiation. Interferon-based antiviral treatment was initiated in more than one third of chronic HCV infected patients visiting university hospitals, who were young, employed, HCV genotype 2, and with abnormal ALT without HCC, in Korea.
慢性丙型肝炎病毒（HCV）感染的识别和治疗不足是影响疾病结局的一个重要决定因素。本研究旨在调查一项前瞻性、多中心韩国 HCV 队列中慢性丙型肝炎患者接受干扰素为基础的抗病毒治疗的治疗率及其启动因素。2007 年 1 月至 2013 年期间，在六所大学医院共前瞻性随访了 759 例初治慢性 HCV 感染患者，中位（四分位间距）随访时间为 769（76-1427）天。受试者包括慢性丙型肝炎（n=553，72.9%）、肝硬化（n=127，16.7%）和肝细胞癌（n=79，10.4%）患者，通常采用聚乙二醇干扰素α和利巴韦林治疗。分析了治疗启动率及其相关因素。抗病毒治疗的启动率为 37.3%（n=273），5 年内治疗启动的累积概率为 39.4%。多变量分析显示，年龄<58 岁（风险比[HR] 1.588，95%可信区间[CI] 1.151-2.193）、在职（HR 1.737，95%CI 1.279-2.363）、无肝细胞癌（慢性肝炎，HR 2.534，95%CI 1.003-6.400；肝硬化，HR 2.873，95%CI 1.101-7.494）、丙氨酸氨基转移酶（ALT）>40IU/L（HR 1.682，95%CI 1.228-2.303）和基因型 2（HR 1.364，95%CI 1.034-1.798）是与治疗启动相关的独立因素。在韩国，大学医院就诊的慢性 HCV 感染患者中，超过三分之一的患者接受了干扰素为基础的抗病毒治疗，这些患者年轻、在职、感染 HCV 基因型 2 且伴有 ALT 异常但无肝细胞癌。
