Hepatitis C Treatment Following Referral Associated with Marital Status, HIV Presence
Study finds there are often long delays between diagnosis and referral for treatment by a specialist for patients with hepatitis C, and also long delays from the time of referral to initiation of treatment.
According to a recent retrospective cross-sectional study, a relatively small proportion of hepatitis C patients referred for treatment follow through. Furthermore, the time lapse between referral and treatment is significantly shorter in those who are married, are HIV positive, or have any pre-existing comorbidities.
Wei B. Ooi, MD, from the Baystate Medical Center at the Tufts University School of Medicine in Boston, MA, and colleagues reported their findings at the 2nd annual IDWeek conference in San Francisco, CA, on October 3, 2013.
Hepatitis C is a blood-borne illness of the liver that infects 3.2 million Americans chronically. Recent advances in hepatitis C treatment have introduced less toxic, more effective methods for treating the condition. These, along with new recommendations for chronic hepatitis C screening, will likely increase the number of hepatitis C diagnoses and patients seeking treatment. Timely evaluation and referral for treatment by providers experienced with hepatitis C management is essential to avoid possible complications associated with the hepatitis C virus, according to Ooi.
The present study investigated referral and treatment patterns in patients diagnosed with hepatitis C, as well as the characteristics associated with a delay in hepatitis C referral and treatment. The investigators evaluated records of patients who had visited the Baystate Medical Center at least once within the past two years, had been diagnosed with hepatitis C, and were not under the care of an infectious disease or hepatitis C specialist.
Most of the patients (92%) diagnosed with hepatitis C were referred for treatment. The median duration from diagnosis to referral was 411 days. A total of 145 patients (approximately 68% of referred patients) visited a hepatitis C specialist, but only 26 patients started treatment. The median duration from referral to treatment was 226 days, possibly reflecting the chronic nature of disease progression and the providers’ viewpoints on the management of hepatitis C, according to the researchers.
Marital status significantly predicted whether an individual visited a hepatitis C specialist. Approximately 27% of the patients who visited a specialist were married, whereas six percent of patients who did not visit a specialist were married. The authors believed that being married may provide social support and encourage patients to seek treatment.
HIV co-infection and comorbid medical conditions were associated with a shorter duration between diagnosis and referral. Patients with these conditions may visit the clinic more regularly, and provider awareness of their multiple conditions may encourage more prompt treatment, according to Ooi and colleagues.
The relatively low proportion of individuals who sought treatment for hepatitis C is likely due to multiple patient, healthcare provider, and systemic factors. In particular, the lack of patient-initiated follow-up may be due to the reported side effects and complexity of the therapies, which may discourage patients from initiating treatment, according to Ooi. Treatments that are simpler and less toxic may help encourage patients and providers to undergo the process. Further prospective studies investigating the referral and treatment patterns of hepatitis C patients, particularly with the new treatments, may help confirm the findings of the present study, according to the researchers.
The authors have nothing to disclose.
