Hepatitis C Virus Spontaneous Clearance Rates in a Rural Veteran Affairs Clinic

Abstract

Purpose: Hepatitis C virus (HCV) is a widely recognized pathological entity, especially in the veteran population. Veterans enrolled in a midwestern veteran hospital and clinic represent a rural population, with the prevalence of hepatitis C presumably mirroring that of urban VAs. No data has been published to fully evaluate the HCV spontaneous clearance rates (SCR) in a rural-based VA hospital or clinic. The purpose of this study is to evaluate the spontaneous clearance rates of HCV in rural veterans in a nurse-managed hepatology clinic. Methods: After VA/IRB approval, the rural VA database was searched retrospectively from 2000 to 2006, to identify veterans who were HCV positive. HCV RNA viral loads were assessed to determine viremia versus spontaneous clearance. Spontaneous clearance of HCV was defined as HCV antibody positive and a serum HCV RNA viral load of <50 IU/ml without treatment. 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: The VA database search identified 395 veterans with Hepatitis C. Of these, 46 (11.6%) had HCV RNA < 50 IU/ml (i.e. SCR) and 107 patients had viremia. The mean age of the veterans with SCR was 54.86 ± 8.43 (SD), with 41 male and 5 female noted. Race was primarily Caucasian with two African-American females. Mean body mass index (BMI) of SCR veterans was 29.2 ± 6.43 (SD). Among these veterans, females had a mean BMI of 27.6 ± 3.89 (SD), and males had a mean BMI of 29.4 ± 6.69 (SD). The difference among veterans with SCR and viremia are shown in Table 1. Liver biopsy was performed in two veterans in which both had fibrosis scores of F4.Table 1: Shows the differences among HCV patients with spontaneous clearance of virus and patients with viremiaConclusion: Rural midwestern veterans had a 12% spontaneous clearance rate of HCV. Veterans with SCR were older when compared to veterans with viremia. There was no statistically significant difference in BMI, co-morbid illness, sex, and race between veterans with SCR and viremia.