CHU de Rennes, Unité d'Addictologie, F-35033 Rennes, France.
J Hepatol. 2012 Feb;56(2):334-40. doi: 10.1016/j.jhep.2011.05.021. Epub 2011 Jul 12.
BACKGROUND & AIMS: Guidelines recommend 6 months of alcohol abstinence before treating hepatitis C (HCV). Abstinence is difficult for alcohol-dependent patients to achieve. This study evaluated HCV treatment in alcoholic patients with ongoing consumption or less than 6 months of abstinence.
A multidisciplinary management model was built by a liver unit and two centers involved in the care of addict patients. Patients were included in a prospective observational study of treatment with pegylated interferon and ribavirin if they presented alcohol dependence with ongoing intoxication or abstinence of less than 6 months. Pre-therapeutic evaluation and follow-up were multidisciplinary, and addiction care was personalized to patient condition and willingness. Alcohol abstinence or reduction was encouraged but not mandatory. The primary end point was sustained virological response (SVR). Results were compared to a control group of patients matched for genotype, viral load, fibrosis stage, sex, and age.
A total of 73 patients treated between 2002 and 2008 were included in the study. Intent to treat analysis showed an SVR in 48% (35/73) of patients versus 49% (36/73) of controls. Low viral load and length of abstinence during treatment were independently associated with SVR. During treatment, 20 (27%) patients were abstinent, 23 (32%) had controlled consumption, and 24 (33%) had excessive consumption. At the end of the follow-up, 22 (30%) patients were durably abstinent.
A multidisciplinary approach allowed HCV treatment in alcohol-dependent patients with a satisfactory SVR rate and positive effects on addiction behavior.
指南建议在治疗丙型肝炎（HCV）之前戒酒 6 个月。对于酒精依赖患者来说，戒酒是很难做到的。本研究评估了正在饮酒或戒酒时间不足 6 个月的酒精性患者的 HCV 治疗情况。
一个肝脏科和两个成瘾患者治疗中心建立了多学科管理模式。如果患者存在酒精依赖且处于持续醉酒或戒酒时间不足 6 个月，则将其纳入聚乙二醇干扰素和利巴韦林治疗的前瞻性观察性研究。治疗前评估和随访采用多学科方法，针对患者的具体情况和意愿提供个性化的成瘾治疗。鼓励但不强制患者戒酒或减少饮酒量。主要终点是持续病毒学应答（SVR）。结果与基因型、病毒载量、纤维化分期、性别和年龄匹配的对照组患者进行比较。
共纳入 2002 年至 2008 年期间治疗的 73 例患者。意向治疗分析显示，治疗组患者的 SVR 为 48%（35/73），对照组为 49%（36/73）。低病毒载量和治疗期间戒酒时间长短与 SVR 独立相关。治疗期间，20 例（27%）患者戒酒，23 例（32%）患者控制饮酒量，24 例（33%）患者过度饮酒。随访结束时，22 例（30%）患者持续戒酒。
多学科方法允许对酒精依赖患者进行 HCV 治疗，获得了令人满意的 SVR 率，并对成瘾行为产生了积极影响。
