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HSR&D 2004 National Meeting Abstracts

1006. Epidemiology of Hepatitis C and Eligibility for Antiviral Therapy
Edward J Bini, MD, New York VAMC, N Brau, Bronx VAMC, S Currie, San Francisco VAMC, H Shen, San Francisco VAMC, BS Anand, Houston VAMC, K Hu, Loma Linda VAMC, L Jeffers, Miami VAMC, SB Ho, Minneapolis VAMC, D Johnson, Bay Pines VAMC, W Schmidt, Iowa City VAMC, P King, Columbia VAMC, R Chueng, Palo Alto VAMC, TR Morgan, Long Beach VAMC, J Awad, Nashville VAMC, M Pedrosa, Boston VAMC, KM Chang, Philadelphia VAMC, A Aytaman, Brooklyn VAMC, F Simon, Denver VAMC, C Hagedorn, Atlanta VAMC, R Moseley, Ann Arbor VAMC, J Ahmad, Pittsburg VAMC, C Mendenhall, Cincinnati VAMC, B Waters, Memphis VAMC, D Strader, Washington VAMC, AW Sasaki, Portland VAMC, S Rossi, San Francisco VAMC, TL Wright, San Francisco VAMC

Objectives: To evaluate the epidemiology of hepatitis C virus (HCV) infection among veterans and to determine the proportion of patients that are treatment candidates.

Methods: 4,462 veterans were prospectively enrolled at 21 VA medical centers over a 1-year period. All subjects were HCV antibody positive and under evaluation for interferon and ribavirin therapy.

Results: The mean age of the 4,462 patients was 50.3 7.6 years, 97.2% were male, and 29.4% were African American. The majority were Vietnam-era veterans (76.7%), 47.1% completed 12 years or less of education, and 39.0% had an annual income of $10,000 or less. Injection drug use (60.0%), incarceration for more than 48 hours (61.4%), cocaine use (67.6%), more than 20 lifetime sexual partners (38.5%), and sex with a prostitute (57.6%) were common risk factors. Only 24.8% were candidates for treatment according to the VA HCV Treatment Guidelines, while 39.4% were considered eligible for therapy by the treating clinician. Multivariate analysis identified ongoing substance abuse (OR 17.3; 95% CI, 12.8 23.4), psychiatric disease (OR 9.9; 95% CI, 7.3 13.4), comorbid medical disease (OR 9.1; 95% CI, 6.8 12.0), thrombocytopenia (OR 8.3; 95% CI, 5.2 13.3), normal ALT levels (OR 7.1; 95% CI, 5.8 8.8), and age (OR 1.04; 95% CI, 1.03 1.05) as predictors of not being a treatment candidate. Of the patients who were considered a treatment candidate, only 54.1% agreed to receive treatment.

Conclusions: Ongoing substance abuse, active psychiatric disease, and comorbid medical disease are common among veterans with HCV, and the majority of these patients are not suitable candidates for interferon-based treatment. Multidisciplinary collaboration is needed to overcome barriers to care and to improve treatment candidacy in this population.