Krook Aud L, Stokka Dorthe, Heger Bernt, Nygaard Egil
Unit for Addiction Medicine, Institute of Psychiatry, University of Oslo, and Clinic of Abuse and Dependence, Aker University Hospital HF, Oslo, Norway.
Eur Addict Res. 2007;13(4):216-21. doi: 10.1159/000104884.
Many physicians are still skeptic to treat opioid dependants, with or without maintenance treatment, for hepatitis C (HCV) because of concerns about psychiatric comorbidity, stability and adherence. In Norway, there are about 3,500 patients participating in the restrictive medication-assisted rehabilitation (LAR) programs in which all patients are given methadone or buprenorphine maintenance therapy. This study was undertaken to determine whether HCV combination therapy with pegylated interferon alpha-2a plus ribavirin is feasible, efficient and safe in this patient group.
Seventeen patients with HCV genotype 3a were treated for 24 weeks. To optimize compliance, the treatment was given from a department of infectious diseases in cooperation with an LAR center. All injections were given in the LAR center and the patients were given psychosocial support.
The compliance was 100%. All responded to the therapy and 16 (94%) were sustained responders.
DISCUSSION/CONCLUSION: This study indicates that compliance and treatment outcome of opioid dependants on methadone or buprenorphine maintenance after 24 weeks of HCV treatment corresponds to that for non-dependants if extra support is given. The treatment should be undertaken in collaboration with specialists in addiction medicine, hepatology and infectious diseases.
许多医生对于治疗阿片类药物依赖者（无论是否接受维持治疗）的丙型肝炎（HCV）仍持怀疑态度，原因是担心其存在精神疾病共病、稳定性和依从性问题。在挪威，约有3500名患者参与了限制性药物辅助康复（LAR）项目，所有患者均接受美沙酮或丁丙诺啡维持治疗。本研究旨在确定聚乙二醇化干扰素α-2a联合利巴韦林的HCV联合疗法在该患者群体中是否可行、有效且安全。
17例HCV基因3a型患者接受了为期24周的治疗。为优化依从性，治疗由传染病科与LAR中心合作进行。所有注射均在LAR中心进行，患者还获得了心理社会支持。
依从率为100%。所有患者对治疗均有反应，16例（94%）为持续应答者。
讨论/结论：本研究表明，如果给予额外支持，接受美沙酮或丁丙诺啡维持治疗的阿片类药物依赖者在HCV治疗24周后的依从性和治疗结果与非依赖者相当。该治疗应与成瘾医学、肝病学和传染病学专家合作进行。
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