Chronic Hepatitis C virus infection in Swiss primary care practices: Low case loads—high barriers to treatment?

Figures & data

Figure 1. Chronic Hepatitis C monitoring organized by primary care physicians.

Table I. Primary care physicians’ reasons for withholding antiviral treatment.

Patient related reasons:	n	%	HCV related reasons:	n	%
Patient preference	295	26.2	Normal liver enzymes	284	25.3
Drug problem	131	11.6	Previously non-responder	59	5.3
Old age	125	11.1	Biopsy result	35	3.1
Alcohol problem	53	4.7	Difficult-to-treat genotype	18	1.6
Compliance problem	48	4.3	Patient asymptomatic	7	0.6
Depression	28	2.5	Spontaneous clearance	4	0.3
HIV co-infection	19	1.7	Organizational issues:
Patient ‘not stable’	9	0.8	Ongoing investigations	14	1.3
Medical comorbidities	8	0.7	Financial issues	5	0.4
Transplantation	2	0.2	Other:
Pregnancy	2	0.2	Specialist advice	313	27.8
Financial issues	5	0.4	No information	94	8.4

Figure 2. Complementary exams ordered by primary care physicians in the workup of chronic Hepatitis C patients.

Table II. Practical implications for primary care physicians.

Specialist referral for:

Workup completion: a full workup to all HCV patients: viral load, genotype, and biopsy or non-invasive staging of fibrosis

Treatment should not be deferred before these items are determined

Evaluating treatment indication and treatability, especially in seemingly ‘too difficult to treat patients’

Support in conducting treatment and managing adverse effects

Monitoring of HCV patients:

Non-cirrhotic patients: annual transaminases

Cirrhotic patients: six-monthly HCC screening and liver function tests