National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
Gastroenterology. 2010 Jan;138(1):123-35.e1-2. doi: 10.1053/j.gastro.2009.09.019. Epub 2009 Sep 24.
BACKGROUND & AIMS: Patients with acute hepatitis C virus (HCV) infection who receive treatment achieve high rates of sustained virologic response (SVR), but few studies have examined outcomes among injecting drug users (IDUs). We evaluated the efficacy of treatment of recent HCV infection in IDUs with acute and early chronic HCV.
We analyzed data from the Australian Trial in Acute Hepatitis C-a prospective study of the natural history and treatment outcomes of patients with recent HCV infection. Participants eligible for the study had their first anti-HCV antibody-positive test result within the past 6 months and either acute clinical HCV within the past 12 months or documented anti-HCV seroconversion within 24 months. Participants with HCV received pegylated interferon-alfa-2a (180 microg/wk, n = 74); those with HCV/human immunodeficiency virus (HIV) co-infection received pegylated interferon-alfa-2a (180 microg/wk) with ribavirin (n = 35) for 24 weeks.
From June 2004 to February 2008, 167 participants were enrolled in the Australian Trial in Acute Hepatitis C; 79% had injected drugs in the previous 6 months. Among 74 with only HCV, the SVRs were 55% and 72% by intention-to-treat and per-protocol analysis, respectively. In multivariate analyses, baseline factors independently associated with lower SVR included decreased social functioning and current opiate pharmacotherapy. Adherent participants had higher SVR rates (63% vs 29%; P = .025). Of the 35 participants with HCV/HIV co-infection, the SVRs were 74% and 75% by intention-to-treat and per-protocol analysis, respectively.
Treatment of recent HCV infection among IDUs, including those with HIV co-infection, is effective. Strategies to engage socially marginalized individuals and increase adherence should improve treatment outcomes in this population.
急性丙型肝炎病毒（HCV）感染者接受治疗后，可实现高持续病毒学应答（SVR）率，但很少有研究评估注射吸毒者（IDU）中的治疗结局。我们评估了 IDU 中近期 HCV 感染的急性和早期慢性 HCV 治疗效果。
我们分析了澳大利亚急性肝炎试验的数据-一项对近期 HCV 感染患者自然史和治疗结局的前瞻性研究。有资格参加该研究的参与者在过去 6 个月内首次出现抗 HCV 抗体阳性检测结果，并且在过去 12 个月内患有急性临床 HCV 或在 24 个月内有记录的抗 HCV 血清学转换。接受聚乙二醇干扰素-α-2a（180μg/周，n=74）治疗的 HCV 患者；HCV/人类免疫缺陷病毒（HIV）合并感染的患者接受聚乙二醇干扰素-α-2a（180μg/周）联合利巴韦林（n=35）治疗 24 周。
从 2004 年 6 月至 2008 年 2 月，澳大利亚急性肝炎试验共纳入 167 名参与者；79%的参与者在过去 6 个月内有注射吸毒史。在仅患有 HCV 的 74 名患者中，意向治疗和按方案分析的 SVR 率分别为 55%和 72%。在多变量分析中，与较低 SVR 独立相关的基线因素包括社会功能下降和当前阿片类药物治疗。依从性好的患者 SVR 率更高（63%比 29%；P=0.025）。在 35 名 HCV/HIV 合并感染的患者中，意向治疗和按方案分析的 SVR 率分别为 74%和 75%。
IDU 中近期 HCV 感染的治疗，包括 HIV 合并感染的治疗，是有效的。使社会边缘化个体参与和提高依从性的策略应可改善该人群的治疗结局。
