Demographic Differences Affecting the Decision to Defer Treatment for Chronic Hepatitis C (Chcv) Infection

Abstract

Purpose: We have previously compiled data on 115 eligible treatment-naïve CHCV patients who elected to defer therapy [Dig Dis Sci 2007;52:1168–76]. Nearly all patients were asymptomatic, genotype 1, and had mild histologic disease. To assess which demographics affected expectant management after 3 years, a follow-up questionnaire was administered. Methods: Patients were asked their current health status, satisfaction with deferring pegylated interferon/ribavirin (PEG/RBV) using a 2 point Likert scale (not satisfied/satisfied), and whether they had reconsidered their decision to be followed expectantly. An attempt was made to reach all 74 patients from the 2-year cohort. Results: 38 (16 men; mean age 55 years, 17 > age 55; 19 African-Americans [AA]) out of 74 patients (51%) from the 2nd year cohort were contacted. 2 patients had died, 2 refused to answer, and 32 patients were lost to follow-up (43%). 31 out of 38 (82%) responders stated that they were still satisfied with their decision for expectant management. The proportion of non-AA to AA patients continuing to defer treatment (16 [52%] vs. 15 [48%]) was similar to the percentage at 2 years (53% vs. 47%) and 1 year (55% vs. 45%). Men were less likely to continue to defer treatment than women (13 [42%] vs. 18 [58%]), which was similar to proportions seen at the end of 2 years (44% vs. 56%) and 1 year (43% vs. 57%). Patients aged <55 deferred treatment more often than those >55 (17 [55%] vs. 14 [45%]), P= 0.02 compared to 2 year (58% vs. 42%) follow-up and P= 0.02 compared to 1 year (77% vs. 23%) follow-up. Conclusion: A majority of the patients contacted at 3 years with clinically mild genotype 1 CHCV infection remain satisfied with their initial decision to defer treatment. The percentage of younger patients continuing to choose expectant management continued to decline significantly compared with older patients, while older patients are choosing expectant management more often. The patient age variable was statistically significant between years 1 to 2 and 1 to 3. Only a trend was observed for race, where non-AA patients continued to choose expectant management, despite higher rates of sustained viral response (SVR), compared to AA patients (P= 0.5); and for gender where men continue to revisit their decision more frequently than women (P= 0.5). These patients will continue to be followed to determine if theses trends continue.Figure