Brief Article
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World J Gastroenterol. Mar 28, 2012; 18(12): 1339-1347
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1339
Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice
Claus Niederau, Dietrich Hüppe, Elmar Zehnter, Bernd Möller, Renate Heyne, Stefan Christensen, Rainer Pfaff, Arno Theilmeier, Ulrich Alshuth, Stefan Mauss
Claus Niederau, Katholische Kliniken Oberhausen, St. Josef Hospital, Klinik für Innere Medizin, Oberhausen 46045, Germany
Dietrich Hüppe, Medical Office for Gastroenterology and Hepatology, Herne 44623, Germany
Elmar Zehnter, Medical Office for Gastroenterology and Hepatology, Dortmund 44263, Germany
Bernd Möller, Renate Heyne, Medical Office for Gastroenterology and Hepatology, Berlin 10969, Germany
Stefan Christensen, Center for Interdisciplinary Medicine, Mü­nster 48143, Germany
Rainer Pfaff, Medical Office for Gastroenterology and Hepatology, Gießen 35392, Germany
Arno Theilmeier, Medical Office for Gastroenterology and Hepatology, Mönchengladbach 41239, Germany
Ulrich Alshuth, Roche Pharma AG, Medical Management Virology, Grenzach-Wyhlen 79639, Germany
Stefan Mauss, Center for HIV and Hepatogastroenterology, Dü­sseldorf 40237, Germany
Author contributions: Niederau C and Alshuth U performed the data analysis and did most of the writing of the paper; Hüppe D, Alshuth U, Mauss S and Zehnter E were involved in the design of the study; Hüppe D, Alshuth U, Mauss S, Zehnter E, Möller B, Heyne R, Christensen S, Pfaff R and Theilmeier A were involved in the contribution of patients, in the preparation of the analysis, and in the interpretation of the data; all authors were involved in the preparation of the manuscript.
Supported by Investigator fees from by Roche Pharma AG Germany for contributing data to the study
Correspondence to: Claus Niederau, Professor, Katholische Kliniken Oberhausen gGmbH, St. Josef Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Mülheimer Str. 83, 46045 Oberhausen, Germany.
Telephone: +49-208-837301 Fax: +49-208-837309
Received: March 31, 2010
Revised: June 3, 2010
Accepted: June 10, 2010
Published online: March 28, 2012

AIM: To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.

METHODS: This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α 2a/ribavirin, involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings). A structured questionnaire had to be answered prior to the treatment decision, which included demographic data, information about the personal life situation of the patients, anamnesis and symptomatology of hepatitis C, virological data, laboratory data and data on concomitant diseases. A second part of the study analyzes patients treated with pegylated interferon α2a. All questionnaires included reasons against treatment mentioned by the physician.

RESULTS: Overall treatment uptake was 45%. By multivariate analysis, genotype 1/4/5/6, HCV-RNA ≤ 520 000 IU/mL, normal alanine aminotransferase (ALT), platelets ≤ 142 500/μL, age > 56 years, female gender, infection length > 12.5 years, concomitant diseases, human immunodeficiency virus co-infection, liver biopsy not performed, care in private practice, asymptomatic disease, and unemployment were factors associated with reduced treatment rate. Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems. Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.

CONCLUSION: Some reasons against treatment were medically based whereas others were related to fears, socio-economical problems, and information deficits both on the side of physicians and patients.

Keywords: Hepatitis C virus, Interferon, Ribavirin, Liver cirrhosis, Migrants, Treatment barrier