Sylvestre Diana L, Clements Barry J
Department of Medicine, University of California, San Francisco, Oakland, California 94612, USA.
Eur J Gastroenterol Hepatol. 2007 Sep;19(9):741-7. doi: 10.1097/MEG.0b013e3281bcb8d8.
Injection drug users are often denied hepatitis C (HCV) treatment due to concerns about adherence, despite limited data about the impact of such common issues as psychiatric illness and intercurrent drug use. We sought to define the impact of these and other potential adherence barriers in a real-world sample of recovering drug users.
We conducted a prospective observational study of 71 methadone-maintained patients who received interferon and ribavirin combination therapy in a community-based clinic with expertise in treating addictive disorders. Adherence measures were conducted with monthly interview, medication counts, and urine toxicology testing.
Overall, 48 (68%) were adherent, and adherent patients were significantly more likely to achieve a sustained virologic response (42 vs. 4% in nonadherent patients). Patients with and without a prior psychiatric history were similarly adherent (64 vs. 72%, respectively, P>0.5), and the initiation of new psychiatric medications during HCV treatment was associated with improved adherence overall (P=0.02) and in patients that did not report a preexisting psychiatric diagnosis (P=0.04). Trend towards reduced adherence in patients without a period of abstinence was seen before initiating HCV treatment, 46 vs. 72% of those who had been abstinent for at least 1 month (P=0.10). Although occasional drug users were similarly adherent to those who were completely abstinent, patients who relapsed to regular drug use showed a significantly lower level of adherence (P=0.03).
We conclude that the majority of methadone-maintained drug users can adhere to HCV treatment, even those with psychiatric illness and relatively limited pretreatment drug abstinence. Lack of pre-HCV treatment drug abstinence and regular drug use during HCV treatment may be relative barriers to medication adherence, but the initiation of psychiatric medications during HCV treatment may be a helpful intervention. This report provides further evidence for an individualized approach to HCV treatment that does not categorically exclude patients with potential barriers such as mental illness and limited drug abstinence.
尽管关于精神疾病和并发药物使用等常见问题的影响的数据有限，但注射吸毒者常因担心依从性而被拒绝接受丙型肝炎（HCV）治疗。我们试图在一组正在康复的吸毒者的真实样本中确定这些及其他潜在依从性障碍的影响。
我们对71名接受美沙酮维持治疗的患者进行了一项前瞻性观察性研究，这些患者在一家具有治疗成瘾性疾病专业知识的社区诊所接受干扰素和利巴韦林联合治疗。通过每月访谈、药物计数和尿液毒理学检测来评估依从性。
总体而言，48名（68%）患者依从治疗，依从治疗的患者实现持续病毒学应答的可能性显著更高（42%，而非依从患者为4%）。有或无精神病史的患者依从性相似（分别为64%和72%，P>0.5），在HCV治疗期间开始使用新的精神科药物与总体依从性改善相关（P=0.02），在未报告有既往精神疾病诊断的患者中也是如此（P=0.04）。在开始HCV治疗前，未经历一段禁欲期的患者有依从性降低的趋势，禁欲至少1个月的患者为72%，未禁欲患者为46%（P=0.10）。尽管偶尔吸毒者与完全禁欲者的依从性相似，但复吸至经常吸毒的患者依从性显著较低（P=0.03）。
我们得出结论，大多数接受美沙酮维持治疗的吸毒者能够坚持HCV治疗，即使是那些患有精神疾病且治疗前戒毒时间相对有限的患者。HCV治疗前缺乏戒毒和治疗期间经常吸毒可能是药物依从性的相对障碍，但在HCV治疗期间开始使用精神科药物可能是一种有益的干预措施。本报告为HCV治疗的个体化方法提供了进一步证据，该方法不会绝对排除有精神疾病和戒毒时间有限等潜在障碍的患者。
