Reasons Why Patients Infected with Chronic Hepatitis C Virus Choose to Defer Treatment: Do They Alter Their Decision with Time?

Abstract

This study was designed to determine the percentage of treatment-naïve patients infected with chronic hepatitis C virus who make an informed choice to forego (defer) treatment with pegylated interferon regimens in the absence of any medical, psychosocial, or other contraindications, and to reassess their decision by using a questionnaire at least 1 year later. Patient charts dating from 2001 were retrieved and retrospectively analyzed for the following data: patient age, gender, race, hepatitis C viral load, genotype, liver biopsy results, hepatic imaging results, peak alanine aminotransferase (ALT) levels, comorbid conditions, source of infection, estimated duration of infection, and reasons given by the patient for declining pegylated interferon-based treatment at the time of their consultation. A questionnaire survey sought to determine their satisfaction with their initial decision. Of 446 patient charts reviewed, 280 patients were treatment-naïve and were judged to have no contraindications to receiving interferon-based therapy. Of these, 115 (41%) opted to defer treatment and are the subject of this analysis. Women declining therapy outnumbered men by approximately 3 to 2. Middle-aged patients (45-55 years) were most likely to choose expectant therapy compared with older or younger individuals. The proportion of African American patients who deferred therapy (48%) was higher than non-African American patients (36.6%). More than 90% of the patients choosing to be followed were genotype 1. Peak ALT values were normal in 37% and<2X upper limits of normal (ULN) in another 40%. The estimated duration of chronic hepatitis C infection was >16 years in approximately three-quarters of individuals. The most common source of their infection was intravenous drug use followed by transfusion-related. The most common reason for opting not to receive treatment, given by nearly two-thirds of patients, was the asymptomatic nature of their infection coupled with their concern about side effects of the medications. Approximately 10% had unfavorable social situations, including a lack of support or health insurance, that precluded receiving therapy (despite the availability of indigent care programs offered by the pharmaceutical manufacturers). Only five patients (4.3%) cited doubts about efficacy as the main reason that they did not want to be treated. The questionnaire survey at 1 year found that 79% of the patients confirmed their ongoing satisfaction with their initial decision to decline treatment, and another 10.6% indicated that they were still "moderately satisfied" with their decision and unlikely to change it in the near-future. Only six patients (7%) voiced their current dissatisfaction with expectant management and expressed the desire to have a follow-up discussion about treatment options. Of the remaining three patients (3.5%), two had already started treatment and one was deceased (of non-liver-related causes). A significant proportion of patients infected with hepatitis C virus who are otherwise eligible for the...

African Americans May Differ in Their Reasons for Declining Hepatitis C Therapy Compared to Non-African Americans

“…Increased efforts should be made to encourage HCV treatment in appropriate patients in effort to decrease morbidity and mortality related to the disease. efficacy as well as the concern over side effects of interferon and ribavirin [1,3]. Both of our medical center populations behaved similarly in this regard, and we suspect similar rates exist in other large urban centers.…”

“…[1], which revealed that of 280 treatment-naïve patients with chronic hepatitis C who had no contraindication to receiving interferon-based therapy, 115 patients declined therapy. African American patients were more likely than non-African American patients to decline treatment.…”

“…African American patients were more likely than non-African American patients to decline treatment. Almost all the patients refused therapy due to the lack of symptoms as well as their concern about medication side effects [1]. The morbidity and mortality of chronic hepatitis C (HCV) and recent advances in treatment supports offering therapy to all eligible patients.…”

Rate and Factors Affecting Treatment Uptake of Patients with Chronic Hepatitis C in a Tertiary Referral Hospital

“…The retrospective nature of our study did not allow us to further investigate socioeconomic and insurance status of these patients. Of note, a previous study showed that patients who decided not to undertake treatment at the initial setting were unlikely to change their decisions over time, as most patients believed they remained asymptomatic [29]. It signified the importance of the assessment and counseling together with provision of financial assistance to HCV-infected patients by an experienced multidisciplinary team at the initial setting.…”

Factors That Influence an HIV Coinfected Patient's Decision to Start Hepatitis C Treatment

“…4,[16][17][18][19] Not surprisingly, a general fear and apprehension regarding side effects and their impact on quality of life and functioning are common among patients considering treatment. [20][21][22] Despite these side effects and related patient concerns, some recommend early treatment for coinfected patients to prevent more serious disease development. 23 Several psychosocial factors may also contribute to a patient's treatment decisions.…”