Comorbidites among Individuals with HCV Infection Are often Cited as Reason for Excluding Patients from Access to Anti-HCV Treatment
Although approximately 55 percent of HCV-infected, treatment-naïve individuals can be cured by antiviral treatment, many of these patients are excluded from anti-HCV treatment or have treatment deferred or halted due to comorbid conditions. Management of these comorbidities needs to be improved in order to improve HCV treatment outcomes in these individuals.
In the current study, investigators from GlaxoSmithKline aimed to estimate the prevalence of comorbidities among HCV patients and to identify and describe comorbidities in treated versus untreated patients.
The researchers conducted a cross-sectional study IHCIS, a large US medical claims database that covers 33 million people. Included in the study were a total of 10,397 HCV patients defined as having (a) at least two ICD-9 diagnosis codes for chronic HCV (b) at least 24 months of follow uptime between 1996 and 2004 (c) no gaps in health coverage and (d) full pharmacy benefits coverage.
Comorbidities were identified at the 3-digit level of ICD-9 codes, excluding general symptoms and acute conditions.
Patients were predominantly male (63%) and the mean age was 47.8 (±9.6) years.
The most prevalent comorbidities identified in the HCV study population were musculoskeletal disorders (55.7%), hypertension (31.7%), lipid metabolism disorders (16.1%), anemia (25.5%), and diabetes mellitus (14.1%).
During the study period, 25.8% received anti-viral treatment for HCV.
When the above common comorbidities were stratified by treatment status, these patients were less likely to have antiviral treatment (p<0.01), except for those with anemia.
In addition, patients with chronic pulmonary heart disease were less likely to be treated.
HCV coinfection with hepatitis B (HBV) or HIV was relatively uncommon (0.49% and 3.35%, respectively) and there was no difference in treatment status in coinfected patients.
Further analyses are ongoing to adjust rates of comorbidities by age, gender and disease severity; and to compare rates to an uninfected population.
Based on these findings, the authors conclude, This is the first systematic profile review of comorbidities in HCV patients. The study indicates that comorbidites are common in the HCV population, and they are important determinants for treatment.
Only 25% of patients received treatment during this study period, and approximately one-third of the HCV population have a comorbidity that would affect the decision to treat.
These results provide an improved understanding of comorbidities, which will allow future targeted drug development to reach a wider proportion of the HCV population.
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