This is also true for the recently licensed protease

inhibitors, which see more markedly improved SVR rates in patients with CHC, GT-1.9-14 As far as we know, this is the first study to assess a potential selection bias in patients with CHC treated within randomized, controlled studies. At least, the outcome of cohort studies in hepatitis C may be influenced by a selection bias.21 Not surprisingly, some baseline characteristics, adherence to treatment, and the IL18B phenotype had the biggest effect on treatment outcome. Patients receiving SOC had more advanced liver disease, a more frequent history of psychiatric disorders, and a substantial proportion was on drug-substitution therapy. Differences in baseline characteristics22-25 reflect inclusion and exclusion criteria and may create “perfect to treat” patients. Whether the slight differences documented in this study are clinically relevant remains unknown, but history of psychiatric disorders, need of drug-substitution therapy, and a higher grade of liver fibrosis may influence treatment outcome, as well. Because of major differences in access to

NVP-BEZ235 in vitro medical care, data from a European study center cannot be directly applied to the U.S. population of HCV patients. It may also be difficult to draw conclusions from the largely homogenous population of HCV patients seen in Vienna to the largely heterogeneous population of HCV patients seen in the United States. In particular, in this study, except for 7 patients (2.3%; 5 Asians and 2 black Africans), all patients were Caucasians, whereas in the United States, approximately 19% and 40% of treatment eligible or noneligible

patients, respectively, are black.26 Analysis of data from the National Health and Nutrition Examination Survey, conducted in 2005-2008, revealed that HCV-positive patients were less likely to be insured than HCV-negative individuals (61.2% versus 81.2%). Of all HCV-positive patients, 66.7% acetylcholine were eligible for anti-HCV treatment, but only 54.3% of HCV-positive treatment candidates had any type of insurance coverage, and only 36.3% of treatment-eligible patients had health insurance.27 In contrast, approximately 99% of all Austrians are insured (including jobless people), and treatment for chronic hepatitis B and C is fully covered. A similar insurance coverage rate was reported from Taiwan.28 Thus, there is no direct financial benefit for patients to participate in a study, and no patient contacted our center for the sole purpose of being enrolled in a clinical trial. All patients were referred from general practitioners for evaluation of CHC and were offered treatment, if there were no contraindications. Our center treats approximately one third of all HCV patients from Vienna as well as the surrounding suburbs. These represent the “typical mix” of patients with CHC (36% with history of drug abuse, 19% infected by blood or blood products, and 42% of unknown etiology).