Kurelac Ivan, Papic Neven, Sakoman Slavko, Orban Mirjana, Dusek Davorka, Coric Marijana, Vince Adriana
Croatian Reference Center for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia.
Hepat Mon. 2011 Dec;11(12):986-92. doi: 10.5812/kowsar.1735143x.4216. Epub 2011 Dec 20.
Hepatitis C virus (HCV) is one of the major infectious disease agents among injecting drug users (IVDUs). However, most of the IVDUs are not still treated.
To examine the treatment course, adherence, tolerability and safety profiles and SVR rates in IVDUs compared to non-IVDUs.
Demographic and clinical data were collected from medical records of 345 adult patients diagnosed with chronic hepatitis C (CHC) who were treated with a PEG-IFN-α and ribavirin in Croatian Reference Center for Viral Hepatitis in Zagreb between January 2003 and January 2010. Efficacy, safety and tolerability treatment profiles were analyzed in IVDUs vs. non-IVDUs. Positive predictors for treatment outcome were evaluated by univariate and multivariate logistic regression.
A total of 106 (30.46%) IVDUs were identified. The IVDUs were mainly male (81.13% vs. 52.30%, P = 0.0001), young (mean ± SD age: 32.46 ± 5.33 y vs. 46.12 ± 11.48 y, P = 0.0001), had lower fibrosis and HAI score (measured by ISHAK) and shorter duration of infection (mean ± SD: 8.98 ± 5.87 vs. 16.79 ± 8.99 y, P = 0.0001) compared to non-IVDU group. In IVDUs, genotype 1a (24.52%) and 3a (38.68%) were predominant. There were no differences in completion rate between the two studied groups. IVDUs achieved a significantly higher rate of overall SVR (70.75% vs. 51.04%, P < 0.0009) and in genotypes 1 and 4 (65.08% vs. 48.73%, P = 0.0294) vs. non-IVDUs. Treatment discontinuation rates due to side-effects were not significantly different in IVDUs and non-IVDUs (2.83% vs. 7.11%, P = 0.1390). IVDU group had a higher rate of lost to follow-up (13.21% vs. 4.60%, P = 0.0071). There were no statistically significant differences in SVR rate between IVDUs with, or without substitution therapy (55.55% vs. 74.62%, P = 0.0866). Independent predictors of SVR were age < 40 years and genotypes 2 and 3. Type of PEG-IFN-α used was not associated with SVR.
Treatment of CHC in IVDUs should strongly be encouraged as they have positive predictors for achieving SVR such as younger age, shorter duration of infection, and consequently favorable histological stage of the disease, and good adherence to treatment. There is no difference in safety and tolerability profiles of treatment in IVDUs compared to patients with no history of drug abuse.
丙型肝炎病毒（HCV）是注射吸毒者（IVDUs）中主要的传染病原体之一。然而，大多数注射吸毒者仍未得到治疗。
与非注射吸毒者相比，研究注射吸毒者的治疗过程、依从性、耐受性、安全性概况及持续病毒学应答（SVR）率。
收集2003年1月至2010年1月在萨格勒布克罗地亚病毒性肝炎参考中心接受聚乙二醇干扰素-α（PEG-IFN-α）和利巴韦林治疗的345例诊断为慢性丙型肝炎（CHC）的成年患者的病历中的人口统计学和临床数据。分析注射吸毒者与非注射吸毒者的疗效、安全性和耐受性治疗概况。通过单因素和多因素逻辑回归评估治疗结果的阳性预测因素。
共识别出106例（30.46%）注射吸毒者。注射吸毒者主要为男性（81.13%对52.30%，P = 0.0001），年龄较轻（平均±标准差年龄：32.46±5.33岁对46.12±11.48岁，P = 0.0001），纤维化和HAI评分（通过ISHAK测量）较低，感染持续时间较短（平均±标准差：8.98±5.87对16.79±8.99年，P = 0.0001），与非注射吸毒者组相比。在注射吸毒者中，1a型（24.52%）和3a型（38.68%）占主导。两个研究组之间的完成率没有差异。与非注射吸毒者相比，注射吸毒者的总体SVR率显著更高（70.75%对51.04%，P < 0.0009），在1型和4型基因型中也是如此（65.08%对48.73%，P = 0.0294）。因副作用导致的治疗中断率在注射吸毒者和非注射吸毒者中没有显著差异（分别为2.83%和7.11%；P = 0.1390）。注射吸毒者组失访率较高（13.21%对4.60%，P = 0.0071）。接受或未接受替代疗法的注射吸毒者的SVR率在统计学上没有显著差异（分别为55.55%和74.62%，P = 0.0866）。SVR的独立预测因素为年龄<40岁以及2型和3型基因型。使用的PEG-IFN-α类型与SVR无关。
应大力鼓励对注射吸毒者进行慢性丙型肝炎治疗，因为他们具有实现SVR的阳性预测因素，比如年龄较小、感染持续时间较短，因此疾病的组织学阶段良好，且对治疗依从性好。与无药物滥用史的患者相比，注射吸毒者治疗的安全性和耐受性概况没有差异。
