Management of Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and Decisions to Treat

Article Figures & Data

Table 1.

Characteristics of Patients (N = 366) by Discussion and Treatment of Hepatitis C

			Not Treated
Characteristics	Total (N = 366) No. (%)	Treated (n = 55) o. (%)	Discussed (n = 179) No. (%)	Not Discussed (n = 132) No. (%)
* P <.01.
† Patients may have more than 1 risk factor listed.
‡ More than 6 partners per year.
§ Possible risk factors for hepatitis C infection.
Male	226 (62)	37 (67)	106 (59)	83 (64)
Female	140 (38)	18 (33)	73 (41)	49 (36)
Mean age at diagnosis, y	40.2	40.1	39.2	41.4
Education*
<12 y	131 (36)	8 (15)	67 (37)	56 (43)
College	212 (58)	44 (80)	102 (57)	66 (51)
College graduate	20 (5)	3 (5)	10 (6)	7 (6)
Race*
White	277 (76)	48 (87)	130 (74)	99 (75)
Others	89 (24)	7 (13)	49 (26)	33 (25)
Current status
Alive	251 (69)	46 (84)	135 (75)	70 (53)
Dead	42 (11)	4 (7)	14 (8)	24 (18)
No contact for 2 years	73 (29)	5 (9)	30 (17)	38 (29)
Risk factors^†
Blood exposure	89 (24)	29 (53)	33 (18)	27 (21)
Intravenous drug use	156 (43)	53 (98)	52 (31)	51 (39)
Cocaine use*	118 (32)	9 (8)	25 (14)	27 (21)
Multiple sex partners^‡	119 (32)	38 (75)	38 (21)	43 (33)
Health care worker*	43 (12)	19 (35)	20 (11)	4 (3)
Immigrant^§	44 (12)	5 (9)	23 (13)	16 (12)
Tattoo^§	60 (16)	19 (35)	25 (14)	16 (12)

Table 2.

Hepatitis C Discussions and Treatment by Source of Diagnosis

			Not Treated
Source of Initial Diagnosis	Total (N = 366) No. (Column %)	Treated (n = 55) No. (Row %)	Discussed (n = 179) No. (Row %)	Not Discussed (n = 132) No. (Row %)
* Statistically significant difference when compared with generalist, discussed vs not discussed (untreated only). All P ≤.009.
† Statistically significant difference when compared with generalist, treated vs untreated. All P ≤.05.
Generalist	149 (41)	24 (16)	91(61)	34 (36)
Other physicians	88 (24)	12 (14)	34 (39)	42 (48)*
Psychiatrist or chemical dependency treatment center	47 (13)	1 (2)^†	23 (49)	23 (49)*
Gastroenterologist, hepatologist	33 (9)	11 (33)^†	15 (45)	7 (21)
Hospital	22 (6)	0^†	8 (36)	14 (64)*
Blood bank	17 (5)	7 (41)^†	6 (35)	4 (24)
Emergency department	10 (3)	0^†	2 (20)	8 (80)*

Table 3.

Documented Reasons for Not Treating Hepatitis C in 179 Patients

Reason	No. (%)
ALT = alanine aminotranserase; AST = aspartate aminotransferase; NIH = National Institutes of Health; HIV = human immunodeficiency virus.
* Potentially reversible comorbidities, n = 80.
† Comorbidities include malignancies under treatment, previous cardiac or renal transplant, ongoing renal dialysis, diabetes with severe complication, vasculitis, multiple sclerosis–progression, ulcerative colitis, debilitating migraine headache, aortic aneurysm.
‡ The 179 patients represent 49% of the total 366 study patients.
Alcohol and drug abuse with or without depression*	34 (19)
Severe comorbidity^†	28 (16)
Depression without chemical dependency*	25 (14)
Refused – no further specifications	23 (13)
ALT, AST normal levels (NIH guidelines 1997)	19 (11)
No trial available, no money, no insurance*	15 (8)
Old age (70–85 y)	12 (7)
End-stage liver disease or cirrhosis	11 (6)
Pregnant at diagnosis, treatment not reconsidered*	3 (2)
End-stage HIV infection, with or without hemophilia	3 (2)
Severe language barrier*	3 (2)
Acute hepatitis C	3 (2)
Total^‡	179 (100)

Table 4.

Comorbid Conditions Recorded in 132 Patients With No Documented Hepatitis C (HVC) Treatment Discussions

Comorbid Condition	No. (%)
* End stage acquired immunodeficiency syndrome , leukemia, hepatocellular carcinoma, diabetes with severe neuropathy, renal rejection after transplant, liver rejection after transplant, rapidly progressive autoimmune disorder, stage IV cardiac disease.
† Potentially remediable conditions n = 47.
‡ The 132 patients represent 36% or of the total 366 study patients.
Severe comorbidity*	42 (32)
No discussion of HCV tests in medical record, patient may be unaware of HCV status^†	31 (24)
Died before treatment considered	24 (18)
Financial barriers mentioned related to other problems^†	13 (10)
Chronic schizophrenia or other psychotic conditions	8 (6)
Old age (70 to 85 y)	3 (2)
Children (0 to 6 y)	3 (2)
Pregnant at diagnosis, treatment not reconsidered^†	3 (2)
Unable to speculate regarding reasons	4 (3)
Severe depression with suicide attempt	1 (1)
Total^‡	132 (100)

Table 5.

Cause of Death in Patients With Hepatitis C

			Not Treated
Cause of Death	Total (n = 42)	Treated (n = 4)	Discussed (n = 14)	Not Discussed (n = 24)
CHF = congestive heart failure; MI = myocardial infarction; AIDS = acquired immunodeficiency syndrome.
* Amyotrophic lateral sclerosis.
† Chronic obstructive pulmonary disease, ruptured cardiac aneurysm (Marfan syndrome), seizure disorder-severe tetraplegia-suffocation.
‡ Renal failure.
End-stage liver disease or hepatocellular carcinoma	17	2	6	9
Cardiovascular diseases (CHF, MI, stroke)	8	1	3	4
Cancer	4	0	0	4
Murder or suicide	4	0	2	2
Infectious diseases (pneumonia, AIDS)	3	0	0	3
Others	6	1*	3†	2‡

The Article in Brief

Chronic hepatitis C is a treatable condition, but little is known about its treatment in the community practice setting. In a Minnesota county, generalist physicians (general internists and family physicians) diagnosed more cases of hepatitis C than any other group of physicians. Generalist physicians may also have central roles in monitoring and treating hepatitis C patients and referring them for specific therapies.