Hepatitis C Virus Response to Pegylated Interferon and Ribavirin at a Nurse-Managed Rural Veterans Affairs Clinic

Abstract

Purpose: Hepatitis C virus (HCV) is becoming a widely recognized pathological entity, especially in the veteran population. Veterans enrolled in a midwest veterans hospital represent a rural population, with the prevalence of hepatitis C presumably mirroring that of urban VAs. No data has been published to fully evaluate HCV RNA sustained virologic response (SVR) and early virologic response (EVR) in a rural-based VA hospital using pegylated interferon and ribavirin. The aim of this study was to evaluate the SVR and EVR rates for rural veterans undergoing HCV treatment through a nurse-managed clinic. Methods: After IRB approval, the rural VA database was searched retrospectively from year 2000 to 2008, to identify veterans who underwent HCV treatment with pegylated interferon and ribavirin. SVR was defined as serum HCV RNA < 50 IU/ml at 24 weeks after completion of treatment. EVR was defined as a decline in the serum HCV RNA load greater than or equal to 2-logs or clearance of the virus by week 12. Categorical variables were compared by Fisher's exact test and chi-square test. Continuous variables were compared by parametric tests. Comparisons were made by univariant and multivariant analysis. Results: Search identified a total of 395 patients with HCV. Treatment was completed by 113 patients, with complete data available on 95 patients. The mean age was 49.3 ± 5.9 (SD), 89 men and 6 women. The mean body mass index was 31.1 ± 6.1 (SD). 65 patients had genotype 1, 14 had genotype 2, and 16 had genotype 3. The SVR for genotype 1 was 52.30% for all patients, 30.77% for non-responders, and 16.92% for relapsers. In these genotype 1 patients, 70.5% of patients with SVR had EVR, while 90% of non-responders and 90% of relapses had EVR. Among genotype 2, SVR was noted in 78.57%, 0 non-responders, and 14.28% relapsers. In genotype 2 patients, 63.64% of SVR patients had EVR, while no EVR was noted in non-responders and relapsers. In genotype 3, SVR was seen in 50%, 12.50% for non-responders and 37.5% for relapsers. Among genotype 3, EVR was seen in 87.5% of patients with SVR, 9.1% of non-responders, and 100% of relapsers. Conclusion: Rural midwestern veterans with Hepatitis C have similar age and SVR rates as those in urban VA hospitals. The SVR rate for genotype 3 was 50% in the VA population which more likely represents a genotype 1 response rate. Therefore genotype 3 veterans will need to be treated more like genotype 1 and treatment for 12 months may be needed to achieve SVR. With 100% of the genotype 3 relapsers achieving an EVR, a longer duration of treatment may be more efficacious