Hepatitis C virus prevalence and outcomes among injecting drug users on opioid replacement therapy
Hepatitis C virus prevalence and outcomes among injecting drug users on opioid replacement therapy
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DOI：
10.1111/j.1440-1746.2005.03882.x
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发表时间：
2005-07-01
影响因子：
4.1
通讯作者：
Dore, GJ
中科院分区：
文献类型：
--
作者：
Hallinan, R;Byrne, A;Dore, GJ
目的：为了确定丙型肝炎病毒（HCV）的感染率注射吸毒者（IDUs）接受阿片类药物替代治疗在一个参考办公室设置，并评估丙型肝炎治疗和护理的潜在需求。方法：数据收集178注射吸毒者接受阿片类药物替代治疗谁进行了临床评估，2002年1月至2003年6月。标准临床方案包括HCV和B型肝炎病毒（HBV）血清学、肝脏生化和HCV RNA分析，用于HCV抗体阳性和丙氨酸氨基转移酶（ALT）水平正常的患者。HCV感染率为75.3%，男性（75.5%）和女性（74.4%）相似，并随年龄增长而增加，从19-30岁的60.8%增加到40岁以上的93.9%。在有HCV抗体且既往未接受过HCV抗病毒治疗的患者（n = 130）中，53.1%的ALT水平正常，25.4%的HCV-RNA阴性。年龄较大的患者更可能有正常的ALT水平（P = 0.02），HCV-RNA阴性（P = 0.02）。年轻患者更有可能接种乙肝疫苗（P < 0.001），然而，不太可能有疫苗或自然免疫（P = 0.006）。在97例可能的慢性HCV感染患者中，58例患者符合HCV治疗的肝活检前标准，34例患者有治疗的相对禁忌症，6例患者已被转诊进行治疗评估。在HCV高流行率的背景下，临床特征使得能够将患者区分为无HCV病毒血症证据的组、慢性HCV感染组、和最适合HCV治疗转诊的那些。这些临床评估沿着适当的转诊应在药物依赖治疗环境中进行。(C)2005年Blackwell Publishing Asia Pty Ltd.
Objectives: To determine hepatitis C virus (HCV) prevalence among injecting drug users (IDUs) receiving opioid replacement therapy in a referred office setting, and assess potential needs for hepatitis C treatment and care.Methods: Data were collected on 178 IDUs receiving opioid replacement therapy who underwent clinical assessment between January 2002 and June 2003. Standard clinic protocols included HCV and hepatitis B virus (HBV) serology, liver biochemistry and HCV RNA analysis for patients with a positive HCV antibody and normal alanine aminotransferase (ALT) levels.Results: HCV prevalence was 75.3%, similar for males (75.5%) and females (74.4%), and increased with age from 60.8% for 19-30 years to 93.9% above 40 years. Among patients with HCV antibodies and no prior HCV antiviral therapy (n = 130), 53.1% had normal ALT levels and 25.4% were HCV-RNA negative. Older patients were more likely to have normal ALT levels (P = 0.02), and be HCV-RNA negative (P = 0.02). Younger patients were more likely to have been HBV vaccinated (P < 0.001), however, were less likely to have either vaccine or natural immunity (P = 0.006). Of 97 patients with probable chronic HCV infection, 58 patients met pre-liver biopsy criteria for HCV treatment, 34 had relative contraindications to treatment and 6 had been referred for treatment assessment.Conclusion: Clinical characterization in a setting of high HCV prevalence has enabled the differentiation of patients into groups with no evidence of HCV viraemia, with chronic HCV infection, and those most appropriate for HCV treatment referral. These clinical assessments along with appropriate referral should be instituted in drug dependency treatment settings. (C) 2005 Blackwell Publishing Asia Pty Ltd.