Weill Cornell Medical College, New York, NY 10065, USA.
Clin Infect Dis. 2013 Mar;56(6):806-16. doi: 10.1093/cid/cis1007. Epub 2012 Dec 7.
Hepatitis C virus (HCV)-infected drug users (DUs) have largely been excluded from HCV care. We conducted a systematic review and meta-analysis of the literature on treatment completion and sustained virologic response (SVR) rates in DUs. We assessed the effects of different treatment approaches and services to promote HCV care among DUs as well as demographic and viral characteristics.
Studies of at least 10 DUs treated with pegylated interferon/ribavirin that reported SVR were analyzed. Heterogeneity was assessed (Cochran test) and investigated (meta-regression), and pooled rates were estimated (random effects).
Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95% confidence interval [CI], 77.1%-88.9%). Among studies that included addiction-treated and untreated patients during HCV therapy, the higher the proportion of addiction-treated patients, the higher the HCV treatment completion rate (P < .0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P < .0001). The pooled SVR rate was 55.5% (95% CI, 50.6%-60.3%). Genotype 1/4 (P = .0012) and the proportion of HIV-coinfected DUs (P = .0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P < .0001).
Treatment of addiction during HCV therapy results in higher treatment completion. Our pooled SVR rate is similar to that obtained in registration trials in the general population. Treatment of addiction during HCV therapy will likely be important for HCV-infected DUs undergoing treatment with more complex regimens including direct-acting antivirals.
丙型肝炎病毒（HCV）感染的吸毒者（DUs）在很大程度上被排除在 HCV 治疗之外。我们对关于 DUs 完成治疗和持续病毒学应答（SVR）率的文献进行了系统评价和荟萃分析。我们评估了不同治疗方法和服务对促进 DUs 接受 HCV 治疗的影响，以及人口统计学和病毒学特征。
分析了至少有 10 名接受聚乙二醇干扰素/利巴韦林治疗的 DUs 完成治疗和 SVR 的研究。评估了异质性（Cochran 检验）并进行了研究（荟萃回归），并估计了汇总率（随机效应）。
共检索到 36 项研究，共包括 2866 名患者。DUs 的治疗完成率为 83.4%（95%置信区间[CI]，77.1%-88.9%）。在包括 HCV 治疗期间接受和未接受成瘾治疗的患者的研究中，接受成瘾治疗的患者比例越高，HCV 治疗完成率越高（P <.0001）。在调整了人类免疫缺陷病毒（HIV）/HCV 合并感染、性别和成瘾治疗后，抗病毒治疗期间的支持服务增加了治疗完成率（P <.0001）。汇总的 SVR 率为 55.5%（95%CI，50.6%-60.3%）。基因型 1/4（P =.0012）和 HIV 合并感染的 DUs 比例（P =.0173）影响了 SVR 率。在调整了 HCV 基因型 1/4 和 HIV/HCV 合并感染后，SVR 率与多学科团队的参与呈正相关（P <.0001）。
在 HCV 治疗期间治疗成瘾可提高治疗完成率。我们的汇总 SVR 率与一般人群注册试验中获得的结果相似。对于接受更复杂方案治疗的 HCV 感染的 DUs，包括直接作用抗病毒药物，治疗 HCV 期间治疗成瘾可能很重要。
