Centre for Interdisciplinary Addiction Research, Hamburg University, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany; Institute for Therapy Research, Parzivalstrasse 25, 80804 Munich, Germany.
Drug Alcohol Depend. 2010 Jun 1;109(1-3):248-51. doi: 10.1016/j.drugalcdep.2010.01.009. Epub 2010 Feb 18.
Severely opioid-dependent patients are at high risk of both acquiring and spreading the hepatitis C virus (HCV). It is uncertain, however, whether these patients are possible candidates for HCV treatment. We therefore explored treatment retention and adherence as well as sustained viral response in co-morbid severely opioid-dependent subjects under heroin maintenance, who previously failed in conventional substitution treatment or were not in any drug treatment.
All patients in heroin maintenance in the German heroin trial, who received standard antiviral HCV therapy with pegylated interferon and ribavirin, were included. Co-consumption of licit and illicit drugs was tolerated as long as it did not interfere with treatment.
Twenty-six patients in heroin maintenance were treated for chronic HCV infection. Both the Global Severity Index of the Symptom Checklist 90-R (average score 65.9) and the Opiate Treatment Index (average score 16.6) indicated relevant co-morbidity. Twenty-one patients (81%) were retained in treatment; the adherence rate was 92%. Eighteen patients (69%) achieved a sustained viral response, with a 100% response rate for genotype 2, 90% for genotype 3, and 42% for genotype 1.
This is the first study that investigates the feasibility of antiviral HCV treatment in a well-defined sample of co-morbid severely opioid-dependent subjects in heroin maintenance treatment. Viral response rates are comparable to non-drug-user populations. Within a need-adapted treatment setting, HCV treatment may even be extended to difficult-to-treat opioid-dependent patients.
严重阿片类药物依赖患者感染和传播丙型肝炎病毒（HCV）的风险均较高。然而，这些患者是否可能成为 HCV 治疗的候选者尚不确定。因此，我们探讨了在接受海洛因维持治疗的合并严重阿片类药物依赖的受试者中，那些先前在常规替代治疗中失败或未接受任何药物治疗的患者的治疗保留率和依从性以及持续病毒应答情况。
所有在德国海洛因试验中接受海洛因维持治疗的患者均接受聚乙二醇干扰素和利巴韦林标准抗病毒 HCV 治疗。只要不影响治疗，可同时使用合法和非法药物。
26 名接受海洛因维持治疗的患者接受了慢性 HCV 感染的治疗。症状清单 90-R 的全球严重程度指数（平均得分 65.9）和阿片类药物治疗指数（平均得分 16.6）均表明存在相关合并症。21 名患者（81%）保留在治疗中；依从率为 92%。18 名患者（69%）获得持续病毒应答，基因型 2 的应答率为 100%，基因型 3 的应答率为 90%，基因型 1 的应答率为 42%。
这是第一项在明确界定的海洛因维持治疗合并严重阿片类药物依赖患者样本中研究抗病毒 HCV 治疗可行性的研究。病毒应答率与非吸毒者人群相当。在适应需求的治疗环境中，HCV 治疗甚至可以扩展到难以治疗的阿片类药物依赖患者。
