Hallinan Richard, Byrne Andrew, Dore Gregory J
The Byrne Surgery. Redfern, NSW, Australia.
Drug Alcohol Rev. 2007 Jul;26(4):437-43. doi: 10.1080/09595230701373933.
While harm reduction advocates, policy makers and practitioners have a right to be proud of the impact of interventions such as needle and syringe programmes on HIV risk, we can be less sanguine about the ongoing high levels of HCV transmission among injecting drug users (IDUs) and the expanding burden of hepatitis C virus (HCV)-related liver disease. In this Harm Reduction Digest Drs Byrne and Hallinan from the Redfern Clinic and Dr Dore from the National Centre in HIV Epidemiology and Clinical Research offer a model of integrated HCV prevention and treatment services within the setting of opioid pharmacotherapy. In their experience, this common-sense approach provides an opportunity to reduce the burden of HCV and improve overall patient management. They believe that the key elements of a HCV-specific harm reduction model include: regular HCV testing; clinical assessment and determination of need for HCV treatment referral; use of broader HCV treatment inclusion criteria; and flexibility in opioid pharmacotherapy dosing. In an environment when our macro harm reduction interventions seem to have, at best, modest impact on HCV transmission, good clinical practice may be our most effective strategy against the HCV epidemic. This paper provides some practical suggestions as to how this can be done.
虽然减少伤害的倡导者、政策制定者和从业者有理由为诸如针头和注射器项目等干预措施对艾滋病毒风险的影响感到自豪，但对于注射吸毒者（IDU）中持续存在的高水平丙型肝炎病毒（HCV）传播以及丙型肝炎病毒（HCV）相关肝病负担的不断加重，我们就不能那么乐观了。在本期《减少伤害文摘》中，来自雷德芬诊所的伯恩博士和哈利南博士以及来自国家艾滋病毒流行病学和临床研究中心的多尔博士提供了一种在阿片类药物药物治疗背景下综合丙型肝炎病毒预防和治疗服务的模式。根据他们的经验，这种常识性方法提供了一个减轻丙型肝炎病毒负担并改善整体患者管理的机会。他们认为，针对丙型肝炎病毒的减少伤害模式的关键要素包括：定期进行丙型肝炎病毒检测；临床评估以及确定丙型肝炎病毒治疗转诊需求；采用更广泛的丙型肝炎病毒治疗纳入标准；以及在阿片类药物药物治疗剂量方面保持灵活性。在我们的宏观减少伤害干预措施似乎对丙型肝炎病毒传播充其量只有适度影响的环境下，良好的临床实践可能是我们应对丙型肝炎病毒流行的最有效策略。本文就如何做到这一点提供了一些实用建议。
