Evaluation of the Significance of Pretreatment Liver Biopsy and Baseline Mental Health Disorder Diagnosis on Hepatitis C Treatment Completion Rates at a Veterans Affairs Medical Center
Objectives. This study was performed to define the overall treatment response rates and treatment completion rates among the population of Hepatitis C infected patients at an urban VA Medical Center. Additionally, we examined whether pretreatment liver biopsy is a positive predictor for treatment completion and if the presence of mental health disorders is a negative predictor for treatment completion. Methods. Retrospective chart review was performed on the 375 patients that were treated for HCV and met the study inclusion parameters between January 1, 2003 and April 1, 2008 at our institution. Clinical data was obtained from the computerized patient record system and was analyzed for respective parameters. Results. Sustained virological response was achieved in 116 (31%) patients. 169 (45%) patients completed a full treatment course. Also, 44% of patients who received a pre-treatment liver biopsy completed treatment versus 46% completion rates for patients who did not receive a pretreatment liver biopsy. Baseline ICD9 diagnosis of a mental health disorder was not associated with higher treatment discontinuation rates. Conclusions. In conclusion, pretreatment liver biopsy was not a positive predictor for treatment completion, and the presence of mental health disorders was not a negative predictor for treatment completion. 1. Background Hepatitis C virus (HCV) is a highly persistent, hepatotropic RNA virus that causes chronic necroinflammatory liver disease [1]. HCV seroprevalence is 2.2% in the world, 1.6% in the USA and as high as 15-16% in select Veterans Affairs Medical Centers (VAMC) [2–6]. Comorbid factors common among the US veteran population, such as advanced age, obesity, HIV coinfection, immunosuppression, and alcohol intake, are associated with accelerated liver disease and progression to cirrhosis in chronically HCV-infected patients [7–9]. HCV-associated cirrhosis (occurring in 20–30% of HCV-infected individuals) results in increased morbidity and mortality due to end stage liver failure and hepatocellular carcinoma (HCC) that may warrant liver transplantation [10–12]. Thus, the goal of HCV therapy is to clear HCV RNA in an effort to prevent or delay liver-related death and/or complications [7, 9]. The desired objective outcome of HCV-directed therapy is a sustained virologic response (SVR), which is defined as an undetectable HCV viral load (VL) 24 weeks after therapy completion and denotes a cure of the infection [7]. Several variables are known to predict the likelihood of SVR with pegylated interferon and ribavirin treatment. Other
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