Antiviral therapy has been shown to reduce the risk of
disease progression, liver damage and death in patients with
chronic hepatitis C virus (HCV)
infection. While
interferon labels recommend that patients with platelet counts below 50 × 10(3) /μL not receive
interferon-based
therapy, it is unknown to what extent thrombocytopaenia influences treatment decisions in practice. This study profiles the reasons for withholding
antiviral treatment in HCV patients with thrombocytopaenia in five European countries. Medical records of 466 patients who had HCV
infection and thrombocytopaenia (platelet count <100 × 10(3) /μL) in 2006 were retrospectively reviewed for clinical characteristics. Collected data included use of
antiviral therapy and reasons for withholding
therapy. In total 184 of 466 patients (39.5%) did not receive
interferon-based
therapy during the study period, with treatment withheld most frequently due to multiple clinical characteristics including
hepatic cirrhosis (16.3%), thrombocytopaenia (16.3%) and age >60 years (10.9%). The reasons for lack of treatment varied among countries, with thrombocytopaenia as a reason being more common in Italy (10.9%) and Spain (20.0%), and less common in France, Germany and the UK (3.2-7.1%). Overall, thrombocytopaenia was reported as the only reason for
withholding treatment in 4.9% of untreated patients. This study demonstrates that thrombocytopaenia is one of many factors, indicative of the poor clinical state of the patient, that contributes to withholding
antiviral treatment. In 4.9% of untreated patients, thrombocytopaenia can be considered as a modifiable factor to enable more HCV patients to receive guideline-recommended
therapy and thus improved clinical outcomes.