{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:59:36Z","timestamp":1787065176472,"version":"build-2736575974"},"reference-count":0,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T00:00:00Z","timestamp":1565913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T00:00:00Z","timestamp":1565913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dig Dis"],"published-print":{"date-parts":[[2020]]},"abstract":"<b><i>Background and Aims:<\/i><\/b> Chronic hepatitis C (CHC) viral infection has a major impact on our health care system. The emergence of direct-acting antiviral agents (DAA) has made treatment simple (oral), efficacious, and safe. However, treatment is expensive and access is variable. Despite great treatment outcomes, only a minority of patients with CHC receive antiviral therapy. This study identifies the barriers to treatment in CHC infection. <b><i>Methods:<\/i><\/b> Study recruited all hepatitis C antibody-positive patients between 2012 and 2016 from a large academic teaching hospital in New York City. Demographic information, clinical data, and insurance information were reviewed. Statistical analysis performed with OR and <i>p<\/i>\u00a0&#x3c;\u00a00.05 reported. <b><i>Result:<\/i><\/b> A total of 1,548 patients with hepatitis C antibody-positive titer were included in the initial analysis. One thousand and twenty-four patients were forwarded to the final analysis after exclusion of 524 patients (for distant resolved hepatitis C viral [HCV] infection [<i>n<\/i> = 42], patients cured with interferon-based regimens [<i>n<\/i> = 94], patients with comorbid conditions [<i>n<\/i> = 176], and patients with an incomplete medical chart [<i>n<\/i> = 212]). In the intention to treat cohort of 1,024 patients, 204 patients achieved a sustained virological response after receiving DAAs (<i>n<\/i> = 204\/1,024 \u2013 20%). The majority of patients had not received DAAs (<i>n<\/i> = 816\/1,024 patients \u2013 80%). Multiple factors resulted in hepatitis C viral infection (HCV) patients not receiving DAAs including the following primary factors: (a) lost to follow-up clinic visits and poor adherence to clinic appointments (<i>n<\/i> = 548 [67%]; <i>p<\/i> value &#x3c;0.0001), (b) active substance abuse (alcoholism and IV drug abuse; <i>n<\/i> = 165 [20%]; <i>p<\/i> value 0.22), (c) patients with significant psychiatric illness (<i>n<\/i> = 103 [12.7%]; <i>p<\/i> value 0.015), and subgroup analysis revealed that 188 (188\/1,024 \u2013 12%) patients had human immunodeficiency virus-1 (HIV-1) and HCV coinfection. Majority of HCV\/HIV coinfected patients had not received DAAs (<i>n<\/i> = 176 [97%]; <i>p<\/i> value &#x3c;0.0001, OR 4.46). The etiology of nontreatment in coinfected HIV\/HCV patients was 73.3% poor adherence, 11.5% active substance abuse including alcohol and IV drug use, and 9% significant psychiatric illness and 6.2% multiple reasons for not receiving HCV treatment. <b><i>Conclusion:<\/i><\/b> Multifactorial barriers are preventing hepatitis C patients from receiving effective DAA therapy. Primary factors include poor compliance, substance abuse, and significant psychiatric illness, with significant overlap between these groups. Subgroup analysis showed a substantial number of high-risk patients with HIV\/HCV coinfection did not receive DAA therapy. A multidisciplinary clinic approach with a hepatologist, ID physicians, social worker, and behavioral health psychologist and case manager should provide a solution to improve diagnosis and treatment with DAA.<\/jats:p>","DOI":"10.1159\/000501821","type":"journal-article","created":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T21:00:32Z","timestamp":1565989232000},"page":"46-52","source":"Crossref","is-referenced-by-count":22,"title":["Identifying Barriers to the Treatment of Chronic Hepatitis C Infection"],"prefix":"10.1159","volume":"38","author":[{"given":"Ahmed","family":"Al-Khazraji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishan","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Saleh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Ashraf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lieber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raza","family":"Malik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2019,8,16]]},"container-title":["Digestive Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/501821","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/501821","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T15:45:45Z","timestamp":1745423145000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000501821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,16]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,8]]},"published-print":{"date-parts":[[2020,1,14]]}},"URL":"https:\/\/doi.org\/10.1159\/000501821","archive":["Portico"],"relation":{},"ISSN":["0257-2753","1421-9875"],"issn-type":[{"value":"0257-2753","type":"print"},{"value":"1421-9875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,16]]}}}