The Warren Alpert Medical School of Brown University, USA.
Drug Alcohol Depend. 2011 Jul 1;116(1-3):233-7. doi: 10.1016/j.drugalcdep.2010.11.016. Epub 2010 Dec 21.
A minority of HIV/HCV coinfected patients with opiate addiction undergo HCV treatment. HCV therapy for HCV-monoinfected methadone maintenance (MM) recipients is safe and effective. We evaluated treatment efficacy and adherence to pegylated interferon (pegIFN) among HIV/HCV coinfected MM recipients.
HCV treatment-naïve, HIV-infected persons 18-65 years with chronic HCV genotype 1 on MM were prospectively enrolled in an HCV treatment study at two HIV clinics. At weekly visits pegIFN alfa-2a injections were directly administered. Daily MM recipients had morning ribavirin delivered with methadone at off-site methadone clinics. Weekly take-home MM recipients took ribavirin unsupervised. Target enrollment was 30 participants.
During 18 recruitment months, 11 participants were enrolled, 6 of whom received daily methadone. Mean age was 46, 64% were female, 5 were Caucasian, 4 Black and 2 Hispanic. At baseline, 82% had high HCV RNA and 55% had stage 2 fibrosis or greater. The majority (91%) were on HAART, and 82% had undetectable HIV RNA with a median CD4(+) of 508cells/μL. All had polysubstance use history, non-substance-based psychiatric diagnoses and were on psychotropic medications pre-enrollment. Two (18%) participants achieved a Sustained Virologic Response (SVR). Two completed 48 treatment weeks, 5 were withdrawn due to adverse events, 2 dropped out prematurely and 2 had treatment discontinued for virologic non-response. Of on-treatment weeks, adherence to pegIFN was >99%.
SVR rate was comparable to historic controls for coinfected genotype 1 patients, with optimal pegIFN adherence. Adverse effects often prevented therapy completion in this population.
少数合并 HIV/HCV 感染且有阿片类药物成瘾的患者会接受 HCV 治疗。HCV 单感染的美沙酮维持治疗（MM）受者接受 HCV 治疗是安全有效的。我们评估了合并 HIV/HCV 感染的 MM 受者中聚乙二醇干扰素（pegIFN）治疗的疗效和依从性。
本前瞻性 HCV 治疗研究纳入了两家 HIV 诊所的 18-65 岁、正在接受 MM 且慢性 HCV 基因型 1 感染的 HIV 阳性、初治 HCV 患者。每周就诊时给予 pegIFN alfa-2a 注射。每日接受 MM 治疗的患者在远离美沙酮诊所的地方，由美沙酮给药的同时给予利巴韦林。每周携带 MM 回家的患者则自行服用利巴韦林。目标入组人数为 30 名。
在 18 个月的招募期间，共入组了 11 名患者，其中 6 名患者每日接受美沙酮治疗。患者的平均年龄为 46 岁，64%为女性，5 名患者为白种人，4 名患者为黑种人，2 名患者为西班牙裔。基线时，82%的患者 HCV RNA 水平较高，55%的患者有 2 期或更严重的纤维化。大多数（91%）患者正在接受高效抗逆转录病毒治疗（HAART），82%的患者 HIV RNA 检测不到，中位 CD4(+)细胞计数为 508 个/μL。所有患者均有药物滥用史，非物质滥用的精神科诊断，并在入组前使用精神药物。2 名（18%）患者获得了持续病毒学应答（SVR）。2 名患者完成了 48 周的治疗，5 名患者因不良反应而退出，2 名患者提前退出，2 名患者因病毒学无应答而停止治疗。在治疗期间，pegIFN 的依从性>99%。
SVR 率与合并感染基因型 1 患者的历史对照相似，pegIFN 依从性良好。在该人群中，不良反应常导致治疗完成失败。
