Hepatitis C management experience in a regional hospital.

Abstract

Background and Aim: Regional hospitals face many limitations to providing quality disease management. Such limitations can affect the standard of management provided to patients. It is important for these hospitals to frequently evaluate disease management especially when there are advancements. This enables issues to be identified and practice modified accordingly. The aim of this study is to assess the standard of hepatitis C management in a regional hospital in the setting of recent advancements in management. Methods: A retrospective analysis of patients undergoing hepatitis C management in a regional hospital from September 2011 until May 2014 was conducted. The management team consisted of one full time gastroenterologist and 2 HCV nurse specialists covering a population of 250 thousand, many of whom are from remote rural areas. Medical records were examined to obtain data. Patients underwent an initial psychiatric assessment and most had a fibroscan or liver biopsy before starting treatment. Patients were divided into 2 genotype specific groups (genotype 1 and genotypes 2&3). These groups were further subdivided depending on whether treatment was completed or not. Genotype 1 received either double therapy (interferon and riboviran) or triple therapy (interferon, riboviran and teleprovir or Boceprevir). Genotypes 2 & 3 received only double therapy. Reasons for not completing were analyzed as well as the cure and relapse rates. Results: A total of 61 patients were treated. 41% (21) had genotype 1, whilst 59% (36) had genotypes 2 and 3. Median age was 44 years old. 15 patients (24%) did not complete the treatment (7 in Genotype 1 and 8 in genotypes 2&3). Genotype 1: 18 completed treatment (72%), 4 of which were on double therapy. Six patients (33%) were null responders (1/4 double therapy and 5/14 triple therapy). Of the 12 responders (66%), 6 had confirmed cure at 6 month review, but unfortunately another 6 were lost to follow up (uncontactable or refused blood test). Of the 7 non-completers (28%), 4 were non-compliant, 1 withdrew and 2 experienced side effects of severe skin rash, uncontrollable drop in Hb or severe abdominal pain. Genotypes 2&3: 28 completed treatment (78%). Three patients (11%) were null responders. Of the 25 responders (89%), 15 had confirmed cure at 6 month review, 3 relapsed and unfortunately 7 were lost to follow up (un-contactable or refused blood test). Of the 8 non-completers (22%), 2 were non-compliant and 6 experienced side effects of severe skin rash, significant psychiatric illness, vomiting and uncontrollable low platelets. Conclusion: This study identified a high response rate in treatment regimes for all genotypes studied at a regional hospital. However it was lower than expected for genotype 1 particularly in the initial stages of triple therapy. Of interest, the side effect profile of triple therapy was found to be no more than that of double therapy. This study highlighted the difficulties regional hospitals can face in regards to patient follow up. The high incidence of patient non-compliance and missing follow up is of concern, which necessitates investigation and modification of practice.