Public Health Service of Amsterdam, Cluster of Infectious Diseases, Department of Research, Amsterdam, The Netherlands.
Eur J Gastroenterol Hepatol. 2012 Nov;24(11):1302-7. doi: 10.1097/MEG.0b013e32835702a8.
More than two-thirds of hepatitis C virus (HCV) infections are associated with injecting drug use. Despite the wide availability of standard treatment with pegylated interferon and ribavirin, active drug users (DU) have limited access to HCV treatment. Physicians may be reluctant to prescribe treatment because of the presumed high risk of reinfection. However, data on reinfection in treated DU remain scarce.
Active DU with chronic HCV infection were treated in a multidisciplinary setting. After achieving a sustained virologic response, patients were tested at 6-12-monthly intervals for HCV RNA. To distinguish between relapse and reinfection, sequence and phylogenetic analyses were performed on the NS5B region of the HCV genome. The incidence of reinfection was calculated using person-time techniques.
From April 2005 to March 2010, 69 active DU treated for HCV had sufficient follow-up, median 2.5 years (interquartile range, 1.6-3.7). Sustained virologic response was achieved in 42 patients (61%). During follow-up, 41 patients remained HCV RNA-negative; of these, two patients died. During treatment, five out of 41 injected drugs, which increased to 11 out of 41 after the end of treatment. One case of reinfection was observed, followed by spontaneous clearance of the virus. The overall incidence was 0.76/100 person-years (95% confidence interval 0.04-3.73). For only those individuals reporting injecting drug use, the incidence was 3.42/100 person-years (95% confidence interval 0.17-16.90).
We report a low incidence of HCV reinfection following treatment in DU participating in a multidisciplinary programme. Active drug use, including injecting, should not preclude access to treatment for HCV.
超过三分之二的丙型肝炎病毒 (HCV) 感染与注射吸毒有关。尽管有广泛的标准治疗方法，即聚乙二醇干扰素和利巴韦林，但活跃的吸毒者 (DU) 获得 HCV 治疗的机会有限。由于假定再次感染的风险较高，医生可能不愿意开处方治疗。然而，关于治疗后的 DU 再次感染的数据仍然很少。
在多学科环境中治疗患有慢性 HCV 感染的活跃 DU。在获得持续病毒学应答后，患者每隔 6-12 个月接受 HCV RNA 检测。为了区分复发和再感染，对 HCV 基因组的 NS5B 区域进行了序列和系统发育分析。使用人员时间技术计算再感染的发生率。
从 2005 年 4 月至 2010 年 3 月，69 名接受 HCV 治疗的活跃 DU 有足够的随访，中位随访时间为 2.5 年（四分位距，1.6-3.7）。42 名患者（61%）实现了持续病毒学应答。在随访期间，41 名患者 HCV RNA 阴性；其中 2 名患者死亡。在治疗期间，5 名患者中有 1 名再次注射毒品，治疗结束后增加到 11 名。观察到 1 例再感染，随后病毒自行清除。总发生率为 0.76/100 人年（95%置信区间 0.04-3.73）。仅报告吸毒的患者中，发生率为 3.42/100 人年（95%置信区间 0.17-16.90）。
我们报告了在参加多学科计划的 DU 中，治疗后 HCV 再感染的发生率较低。活跃的吸毒行为，包括注射吸毒，不应排除 HCV 治疗的机会。
