Some Hep C Patients Going Untreated

Hepatitis C patients had low treatment level in study of US veterans

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Many assume that once patients are diagnosed with a disease, they automatically begin receiving treatment for that condition — but researchers behind a new study warning that this may not be the case for many patients with hepatitis C.

This new study looked at thousands of US veterans with hepatitis C over a decade-long period.

The researchers found that less than a quarter of these patients received treatment at any point after receiving a hepatitis C diagnosis.

"Start an open discussion with your doctor about treatment options."

Hepatitis C is a disease of the liver that develops after the patient becomes infected with the virus of the same name. According to the Centers for Disease Control and Prevention (CDC), the condition can be acute and last only a few months, or chronic, as was the focus in this new study. Most acute cases progress to chronic cases. In chronic hepatitis C, long-term health problems can develop, sometimes resulting in death.

"The treatment most often used for hepatitis C is a combination of two medicines, interferon and ribavirin. However, not every person with chronic hepatitis C needs or will benefit from treatment," CDC explained. "In addition, the drugs may cause serious side effects in some patients."

The researchers behind this new study, led by Jeffrey McCombs, PhD, of the Department of Clinical Pharmacy and Pharmaceutical Economics and Policy at the University of Southern California in Los Angeles, wanted to explore just how many patients were opting for treatment.

The researchers identified patients from the US Department of Veterans Affairs' Hepatitis C clinical registry, a compilation of electronic medical records for over 360,000 patients (most of whom were men) starting in the year 1999.

Dr. McCombs and colleagues identified 128,769 hepatitis C patients from the years 1999 to 2010 for whom all necessary data was available.

Of these patients, only 24.3 percent received treatment for hepatitis C at any point after diagnosis.

Only 16.4 percent of treated patients, or 4.0 percent of all patients, had undetectable levels of the hepatitis C virus in their blood.

The death rate for patients who had undetectable virus levels was 6.8 deaths per 1,000 person-years, compared to a rate of 21.8 deaths per 1,000 person-years among those who did have a detectable virus.

Dr. McCombs and colleagues reported that the patients with an undetectable virus level reduced their risk of death by 45 percent and a liver-related event (like hospitalization from liver problems, liver failure or cirrhosis, scarring of the liver) by 27 percent.

"While antiviral therapy can lead to viral eradication and reduced event risk, its effectiveness under real-world clinical conditions is limited by adverse effects and other factors," the authors of this study wrote. "In this study, only 1 in 4 patients with hepatitis C and a detectable viral load were willing to initiate treatment. Once treated, only a fraction of patients achieved the minimum treatment response of a single undetectable viral load test."

This study was published online November 5 in JAMA Internal Medicine.

Funding for the study was provided by pharmaceutical company Bristol-Myers Squibb. Dr. McCombs received salary and travel funds through a research grant from Bristol-Myers Squibb, and an additional study author is a consultant for the company. One researcher is an employee of the US Department of Veterans Affairs. 

Review Date: 
November 7, 2013
Last Updated:
December 31, 2013