Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice

StephenW

Source: World J Gastroenterol  |  Posted 4 days agoChronic hepatitis C: Treat or wait? Medical decision making in clinical practice; Niederau C, Hüppe D, Zehnter E, Möller B, Heyne R, Christensen S, Pfaff R, Theilmeier A, Alshuth U, Mauss S; World Journal of Gastroenterology 18 (12), 1339-47 (Mar 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.

StephenW

资料来源：世界胃肠病学|发表于4天前
慢性丙型肝炎：治疗或等待？医疗在临床实践中的决定; Niederau，许佩ð，Zehnter E，默勒乙，ŕHeyne，克里斯滕森小号，ŕ百福，Theilmeier一个，Alshuthü，莫斯小号;世界胃肠病学18（12），1339年至1347年杂志（ 3月2012年）

  
目的分析，决定是否与慢性丙型肝炎病毒（HCV）感染患者的治疗或不。
METHODS
This前瞻性队列研究包括7658未经治疗的患者和6341例患者接受聚乙二醇干扰素α2a/ribavirin，整个德国（377私人执业，并在医院设置57），涉及434医生/机构。结构式问卷之前，必须回答的处理决定，其中包括人口统计数据，对患者的个人生活情况，病历和丙型肝炎的症状，病毒学数据，实验室数据和伴随疾病的数据信息。第二部分的研究分析与聚乙二醇重组人干扰素α2a治疗的患者。所有问卷内容包括对医生提到治疗的原因。
RESULTS
Overall治疗的吸收率为45％。多因素分析，基因型1/4/5/6，丙型肝炎病毒RNA≤520 000国际单位/毫升，正常的丙氨酸转氨酶（ALT），血小板≤142500/μL，年龄> 56岁，女性，感染长度> 12.5多年伴随疾病，人类免疫缺陷病毒共同感染，不进行肝活检，照顾私人执业的，无症状的疾病，失业，减少处理率的相关因素。虽然1/3的移民有语言问题，在移民（1/3的队列）的治疗和持续病毒应答率分别高于在德国当地人。处理率和肝活检在临床上设置较高相比，私人执业时，低时，ALT和HCV-RNA的低。对治疗
CONCLUSION
Some原因，医学基础，而其他相关的恐惧，社会经济问题，对医生和患者的一面信息赤字。