Doyle Joseph S, Grebely Jason, Spelman Tim, Alavi Maryam, Matthews Gail V, Thompson Alexander J, Dore Gregory J, Hellard Margaret E
Centre for Population Health, Burnet Institute, Melbourne, Australia.
Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia.
PLoS One. 2016 Jun 29;11(6):e0150655. doi: 10.1371/journal.pone.0150655. eCollection 2016.
Despite effective treatment for recent hepatitis C (HCV) infection, side-effects and adherence concerns limit its use among people who inject drugs (PWID). This study evaluated health-related quality of life (HRQoL) and social functioning following infection and during recent HCV treatment.
The Australian Trial of Acute Hepatitis C studied the natural history and treatment of recent HCV infection. HRQoL (SF-12v2) and social functioning (Opiate Treatment Index score) were measured over 48 weeks and their impact on treatment uptake, adherence and virological response were assessed.
Of 163 participants, 111 received treatment (HCV n = 74, SVR 55%; HCV/HIV n = 37, SVR 74%). 116 (71%) were male, 124 (76%) ever injected drugs, with 55 (36%) injecting recently and 28/55 (51%) reported needle/syringe sharing. At baseline, median physical and mental HRQoL was 54 units (IQR 46-58) and 46 (35-54) (reference median: 50), respectively, and median social functioning score was 11 units (7-17). Higher social function (<10 vs ≥15) predicted increased treatment uptake (AOR 3.43, 95%CI 1.01-11.6, p = 0.048) and higher SVR (AOR 5.11, 95%CI 1.30-20.15, p = 0.020). After adjustment, treated participants had lower physical (-4.90 units, 95%CI -6.33 to -3.48, p<0.001) and mental HRQoL (-3.7 units, 95%CI -5.55 to -1.86, p<0.001) at on-treatment visits, but HRQoL returned to baseline levels during follow-up.
Social functioning can predict recent HCV treatment uptake and SVR. Efforts to maximise social stability may improve treatment response. Pegylated-interferon treatment is associated with reduced HRQoL on-treatment in an already vulnerable population of PWID that would be better served by interferon-free regimens particularly in treated target at PWID to prevent transmission.
ClinicalTrials.gov NCT00192569.
尽管近期丙型肝炎病毒（HCV）感染有有效的治疗方法，但副作用和依从性问题限制了其在注射吸毒者（PWID）中的使用。本研究评估了感染后及近期HCV治疗期间的健康相关生活质量（HRQoL）和社会功能。
澳大利亚急性丙型肝炎试验研究了近期HCV感染的自然史和治疗情况。在48周内测量HRQoL（SF - 12v2）和社会功能（阿片类药物治疗指数评分），并评估它们对治疗接受情况、依从性和病毒学应答的影响。
163名参与者中，111人接受了治疗（HCV感染74人，持续病毒学应答率55%；HCV/HIV合并感染37人，持续病毒学应答率74%）。116人（71%）为男性，124人（76%）曾注射过毒品，其中55人（36%）近期仍在注射，55人中28人（51%）报告有共用针头/注射器的情况。基线时，身体和心理HRQoL的中位数分别为54分（四分位间距46 - 58）和46分（35 - 54）（参考中位数：50），社会功能评分中位数为11分（7 - 17）。较高的社会功能（<10分与≥15分）预示着治疗接受率增加（调整后比值比3.43，95%置信区间1.01 - 11.6，p = 0.048）和较高的持续病毒学应答率（调整后比值比5.11，95%置信区间1.30 - 20.15，p = 0.020）。调整后，接受治疗的参与者在治疗期间的身体HRQoL较低（-4.90分，95%置信区间-6.33至-3.48，p<0.001），心理HRQoL也较低（-3.7分，95%置信区间-5.55至-1.86，p<0.001），但随访期间HRQoL恢复到基线水平。
社会功能可预测近期HCV治疗的接受情况和持续病毒学应答。努力使社会稳定性最大化可能会改善治疗应答。聚乙二醇干扰素治疗与PWID这一弱势群体治疗期间HRQoL降低有关，无干扰素方案对其可能更有益，特别是针对PWID中已接受治疗的目标人群以预防传播。
ClinicalTrials.gov NCT00192569
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