Referral for chronic hepatitis C treatment from a drug dependency treatment setting
Referral for chronic hepatitis C treatment from a drug dependency treatment setting
复制标题
DOI：
10.1016/j.drugalcdep.2006.09.018
复制
发表时间：
2007-04-17
影响因子：
4.2
通讯作者：
Dore, Gregory J.
中科院分区：
文献类型：
--
作者：
Hallinan, Richard;Byrne, Andrew;Dore, Gregory J.
为了检查接受阿片类药物替代治疗的注射吸毒者(IDU)的丙型肝炎病毒(HCV)治疗和初步治疗结果的转诊率和预测因素，2002年12月至2005年11月在悉尼市中心的一家药物依赖治疗诊所进行了一项前瞻性临床审计。大多数注射吸毒者(178/237；75%)是丙型肝炎抗体阳性，其中170人是未接受丙型肝炎治疗的，没有绝对的治疗禁忌症。在这170例患者中，121例(71%)患有慢性丙型肝炎。根据丙型肝炎病毒疾病进展的危险因素，121名慢性丙型肝炎患者中有63名(52%)是转诊的目标；这些患者年龄较大，丙氨酸氨基转移酶水平较高，估计的丙型肝炎病毒感染持续时间较长。在这63名患者中，43人被转诊到肝炎治疗诊所，27人在审计期间就诊。参加治疗评估的患者更有可能是2型或3型(p<；0.001)，但社会行为因素相似。20例患者进行了肝活检，18例患者有中度或重度纤维化。在开始接受聚乙二醇化干扰素-α和利巴韦林治疗的14名患者中，1名因无反应而停止治疗，10名已完成治疗，均为治疗结束(n=4)或持续病毒学应答(n=6)，3名患者正在进行治疗。丙型肝炎病毒治疗转诊标准的发展使患者能够优先转诊，可能会将需要早期评估的患者减半。丙型肝炎病毒的初步治疗结果令人鼓舞，并突出了减轻这一患者群体中肝病负担的潜力。(C)2006爱思唯尔爱尔兰有限公司。保留所有权利。
To examine rates and predictors of referral for hepatitis C virus (HCV) treatment and preliminary treatment outcomes in injecting drug users (IDUs) receiving opioid replacement treatment, a prospective clinical audit was undertaken in an inner city Sydney drug dependency treatment practice between December 2002 and November 2005. The majority of IDUs (178/237; 75%) were HCV antibody positive, of whom 170 were HCV treatment naive with no absolute treatment contraindications. Among these 170 patients, 121 (71%) had chronic HCV. Based on risk factors for HCV disease progression, 63 of 121 (52%) chronic HCV patients were targeted for referral; these patients were older, had higher alanine aminotransferase levels and longer estimated duration of HCV infection. Of these 63 patients, 43 were referred to a hepatitis treatment clinic, and 27 attended during the audit period. Patients who attended for treatment assessment were more likely to have genotype 2 or 3 (p < 0.001), but socio-behavioural factors were similar. Liver biopsy was performed in 20 patients, with moderate or greater fibrosis in 18 patients. Of 14 patients commenced on pegylated interferon-alpha and ribavirin therapy, one ceased treatment due to non-response, 10 have completed treatment, all with an end-of-treatment (n=4) or sustained virological response (n= 6), and treatment is ongoing in three. The development of HCV treatment referral criteria has allowed prioritisation of patients for referral, potentially halving those that require early assessment. Preliminary HCV treatment outcomes are encouraging and highlight the potential for reducing liver disease burden in this patient population. (c) 2006 Elsevier Ireland Ltd. All rights reserved.