Surprisingly small effect of antiviral treatment in patients with hepatitis

antiviral therapies in the general population of persons with hep-atitis C virus (HCV) infection are unknown. Objective: To determine the applicability and usefulness of anti-viral therapy in a metropolitan clinic population. Design: Retrospective case series of consecutively referred pa-tients. Setting: A teaching county hospital in Cleveland, Ohio. Patients: 327 patients referred to a liver clinic after a positive result for antibody against HCV on enzyme-linked immunosorbent assay (ELISA). Measurements: Treatment rates; reasons for nontreatment. Results: 34 patients had no detectable HCV RNA. Of the remain-ing 293 patients, 72 % were not treated for the following reasons: 37 % did not adhere to evaluation procedures, 34 % had medical or psychiatric contraindications, 13 % had ongoing substance or alcohol abuse, 11 % preferred no treatment, and 5 % had normal liver enzyme levels. Only 83 patients (28%) were treated; 13% had a sustained viral response. Conclusion: Most patients with HCV infection are not candi-dates for interferon-based therapies; alternative interventions should be sought for these patients. Ann Intern Med. 2002;136:288-292. www.annals.or