McGovern Barbara H, Wurcel Alysse, Kim Arthur Y, Schulze zur Wiesch Julian, Bica Ioana, Zaman M Tauheed, Timm Joerg, Walker Bruce D, Lauer Georg M
Lemuel Shattuck Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Clin Infect Dis. 2006 Jun 15;42(12):1663-70. doi: 10.1086/504327. Epub 2006 May 11.
The Centers for Disease Control and Prevention has emphasized the need for interventional programs regarding hepatitis C virus (HCV) infection for injection drug users, the group of persons who are at highest risk of acquiring acute infection.
We designed a pilot study to assess the feasibility of identifying injection drug users with acute HCV infection in correctional and detoxification facilities. On-site medical providers were educated regarding risk factors and signs and symptoms of infection and were instructed to refer all patients with hepatitis to our specialty clinic.
Over a 30-month period, 21 patients received a diagnosis of acute hepatitis C, 3 received a diagnosis of hepatitis B, and 1 received a diagnosis of hepatitis A. Of the 21 patients with acute hepatitis C, 19 were identified in the prison setting shortly after incarceration. Of the 17 patients who were observed serially (mean duration of observation, 6.3 months), 8 had spontaneous virologic clearance. Early therapy with pegylated interferon was initiated for 5 patients with persistent viremia and led to a sustained virologic response in 2 individuals. All patients agreed to undergo human immunodeficiency virus counseling and testing, as well as to receive immunization for hepatitis A and B.
Incarceration presents a unique opportunity to identify injection drug users with acute HCV infection, to initiate counseling regarding other bloodborne pathogens, and to facilitate immunizations and HCV treatment.
疾病控制与预防中心强调，针对注射吸毒者开展丙型肝炎病毒（HCV）感染干预项目的必要性，因为这一群体是感染急性HCV的高危人群。
我们设计了一项试点研究，以评估在惩教机构和戒毒所中识别急性HCV感染注射吸毒者的可行性。对现场医疗服务人员进行了感染风险因素、体征和症状方面的培训，并指示他们将所有肝炎患者转诊至我们的专科诊所。
在30个月的时间里，21例患者被诊断为急性丙型肝炎，3例被诊断为乙型肝炎，1例被诊断为甲型肝炎。在21例急性丙型肝炎患者中，19例在入狱后不久即在监狱环境中被识别出来。在17例接受连续观察的患者中（平均观察时长6.3个月），8例实现了病毒学自发清除。对5例持续病毒血症患者启动了聚乙二醇化干扰素早期治疗，其中2例实现了持续病毒学应答。所有患者均同意接受人类免疫缺陷病毒咨询和检测，以及接种甲型和乙型肝炎疫苗。
监禁为识别急性HCV感染的注射吸毒者、开展关于其他血源性病原体的咨询以及促进免疫接种和HCV治疗提供了一个独特的机会。
