Opioid agonist treatment dosage and patient-perceived dosage adequacy, and risk of hepatitis C infection among people who inject drugs
Opioid agonist treatment dosage and patient-perceived dosage adequacy, and risk of hepatitis C infection among people who inject drugs
复制标题
DOI：
10.1503/cmaj.181506
复制
发表时间：
2019-04-29
影响因子：
14.6
通讯作者：
Bruneau, Julie
中科院分区：
文献类型：
--
作者：
Artenie, Andreea A.;Minoyan, Nanor;Bruneau, Julie
背景：阿片类激动剂治疗被认为对于预防注射吸毒者感染丙型肝炎病毒 (HCV) 很重要；然而，剂量在阿片类激动剂治疗中的作用尚不清楚。我们调查了阿片类激动剂治疗的处方剂量和患者感知的剂量充足性与注射吸毒者 HCV 感染风险之间的联合关系。方法：我们对加拿大蒙特利尔（2004-2017 年）有 HCV 感染风险的注射毒品人群（RNA 阴性且 HCV 抗体阴性或阳性）进行了前瞻性追踪。每隔 6 个月，然后每隔 3 个月，对参与者进行 HCV 抗体或 RNA 检测，并完成访谈者管理的行为调查问卷，报告以下内容：当前接受阿片类激动剂治疗的情况（是/否）、处方高剂量（美沙酮 >= 60 mg/d 或丁丙诺啡 >= 16 mg/d）或低剂量，以及感知剂量 充分性（充分/不充分）。然后，我们将参与者分配到 5 个暴露类别中的 1 个：没有阿片类激动剂治疗、认为足够的高剂量阿片类激动剂治疗、认为不充分的高剂量、认为充分的低剂量或认为不充分的低剂量。为了估计阿片类激动剂治疗剂量类别与 HCV 感染事件之间的关联，我们进行了 Cox 回归分析，调整了多个混杂因素。结果：513 名参与者（中位年龄 35.0 岁，77.6% 为男性）中，168 人在 1422.6 人年的随访中感染了 HCV（发病率为 11.8/100 人年，95% 置信区间 [CI] 10.1-13.7）。我们观察到不同阿片类激动剂治疗剂量类别之间 HCV 感染的相对风险存在梯度。与未接受阿片类激动剂治疗的注射毒品者相比，接受高剂量被认为足够的调整后风险比为 0.43 (95% CI 0.23-0.84)，接受高剂量被认为不足的调整后风险比为 0.61 (95% CI 0.25-1.50)，接受低剂量治疗的调整后风险比为 1.22 (95% CI 0.74-2.00)。 接受低剂量的患者被认为是足够的，而接受低剂量的患者则被认为是不足的，为 1.94 (95% CI 1.11-3.39)。解释：丙型肝炎病毒感染的风险根据阿片类激动剂治疗的剂量和患者感知的充分性而有很大差异，相关性表明相对于不接受阿片类激动剂治疗，既有保护作用，也有有害作用。
BACKGROUND: Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS: We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montreal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone >= 60 mg/d or buprenorphine >= 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS: Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION: Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.