Antiviral therapy for hepatitis C appears to be declining in the U.S.; lack of diagnosis is primary barrier to treatment

Researchers from the University of Michigan determined that only 663,000 of the approximately 3.9 million Americans with hepatitis C virus (HCV) infection received antiviral therapy between 2002 and 2007. Treatment rates appear to be declining, in part because only half of the patients know they are infected. If this disturbing trend continues, by 2030 less than 15% of liver-related deaths from HCV will be prevented by antiviral therapy. This study, the first to analyze nationwide practice patterns for HCV treatment, is published in the December issue of Hepatology, a journal of the American Association for the Study of Liver Diseases.

HCV is a common blood-borne infection that slowly damages the liver by causing inflammation of liver tissue, which can lead to cirrhosis, chronic liver disease, and liver cancer. In the U.S., HCV is a major public health burden and the leading cause of liver transplantation. According to the Centers for Disease Control and Prevention (CDC) 8,000-12,000 deaths occur each year due to HCV. While the incidence of new infections has declined, past studies point to a twofold to fourfold increase in death over the next 20 years due to widespread cases with longstanding infection.

Michael Volk, M.D., M.Sc., and colleagues obtained data of new patient prescriptions for pegylated interferon alpha-2a and -2b, sold under the brand names Pegasys and Peg Intron, respectively, and filled between 2002- 2007. Results of the prescription audit showed there were 126,000 new prescriptions for pegylated interferon products in 2002 and by 2007 that figured declined to 83,000 prescriptions. Researchers project fewer than 1.4 million patients would be treated cumulatively with antiviral medication by 2030 if the downward trend continued.

To further understand the decrease in antiviral therapy, researchers investigated treatment decisions using data from the National Health and Nutrition Evaluation Survey (NHANES) Hepatitis C Follow-Up Questionnaire. They discovered that 49% of respondents were previously unaware of their diagnosis and 24% of patients with HCV were not recommended for treatment by their physician. Approximately 9% of those surveyed did not follow up with their doctors regarding their HCV, 8% refused treatment, and only 12% received treatment. "It is concerning that half of all people with hepatitis C in the U.S. are unaware of their diagnosis," said Dr. Volk. "Even with the development of new and better medications on the horizon, such medications will have less than optimal impact unless more patients are diagnosed and referred for treatment."

The study further suggested that barriers to HCV screening may be attributed to lack of health insurance, limited access to standard medical care, and lower priority for testing by primary care doctors. "This is unfortunate," added Dr. Volk, "since young patients who don't go to the doctor often may be the best candidates for antiviral therapy." The authors conclude that increased public health efforts are needed to improve access to antiviral therapy, and recommend further research of health services delivery and quality of care for HCV patients.