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

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

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  • NSTL
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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 α2a/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.

Hepatitis C virusInterferon, RibavirinLiver cirrhosisMigrantsTreatment barrier

Claus Niederau、Dietrich Hüppe、Elmar Zehnter、Bernd M(o)ller、Renate Heyne、Stefan Christensen、Rainer Pfaff

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Katholische Kliniken Oberhausen, St.Josef Hospital, Klinik für Innere Medizin, Oberhausen 46045, Germany

Medical Office for Gastroenterology and Hepatology, Herne 44623, Germany

Medical Office for Gastroenterology and Hepatology, Dortmund 44263, Germany

Medical Office for Gastroenterology and Hepatology, Berlin 10969, Germany

Center for Interdisciplinary Medicine, Münster 48143, Germany

Medical Office for Gastroenterology and Hepatology, Gieβen 35392, Germany

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2012

10.3748/wjg.v18.i12.1339

世界胃肠病学杂志(英文版)
太原消化病研治中心

世界胃肠病学杂志(英文版)

SCI
影响因子：1.001
ISSN：1007-9327
年,卷(期)：2012.18(12)
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