在接受丙型肝炎病毒感染治疗期间和之后，注射吸毒者的风险行为变化：ACTIVATE 研究。
Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study.
机构信息
Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway; The Kirby Institute, UNSW Sydney, Australia; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
The Kirby Institute, UNSW Sydney, Australia.
出版信息
Int J Drug Policy. 2017 Sep;47:230-238. doi: 10.1016/j.drugpo.2017.05.040. Epub 2017 Jun 19.
BACKGROUND
The risk of hepatitis C virus (HCV) reinfection due to continued injecting risk behaviours might remain a barrier to HCV treatment among people who inject drugs. We aimed to evaluate changes in risk behaviours during and following HCV treatment among people with ongoing injecting drug use or receiving opioid substitution treatment (OST).
METHODS
ACTIVATE was an international multicentre clinical trial conducted between 2012 and 2014. Participants with HCV genotypes 2/3 infection were treated with peg-interferon/ribavirin for 12 or 24 weeks and completed a self-administered behavioural questionnaire at each study visit. The impact of time in treatment and follow-up on longitudinally measured recent (past month) behavioural outcomes was evaluated using generalized estimating equations.
RESULTS
Among 93 enrolled participants (83% male, median age 41 years), 55 (59%) had injected in the past month. Any injecting drug use decreased during HCV treatment and follow-up (OR 0.89 per incremental study visit; 95% CI 0.83-0.95). No significant changes were found in ≥daily injecting (OR 0.98; 95% CI 0.89-1.07), use of non-sterile needles (OR 0.94; 95% CI 0.79-1.12), sharing of injecting paraphernalia (OR 0.87; 95% CI 0.70-1.07) or non-injecting drug use (OR 1.01; 95% CI 0.92-1.10). Hazardous alcohol use decreased throughout (OR 0.56; 95% CI 0.40-0.77) and OST increased between enrolment and end of treatment (OR 1.48; 95% CI 1.07-2.04).
CONCLUSIONS
Recent injecting drug use and hazardous alcohol use decreased, while OST increased during and following HCV treatment among participants with ongoing injecting drug use. These findings support further expansion of HCV care among PWID.
背景
由于持续存在的注射风险行为，丙型肝炎病毒（HCV）再感染的风险可能仍然是影响注射吸毒者接受 HCV 治疗的一个障碍。我们旨在评估正在接受注射吸毒或接受阿片类药物替代治疗（OST）的人群在 HCV 治疗期间和治疗后行为的变化。
方法
ACTIVATE 是一项于 2012 年至 2014 年期间进行的国际多中心临床试验。患有 HCV 基因型 2/3 感染的参与者接受聚乙二醇干扰素/利巴韦林治疗 12 或 24 周，并在每次研究就诊时完成自我管理的行为问卷。使用广义估计方程评估治疗和随访时间对纵向测量的最近（过去一个月）行为结果的影响。
结果
在 93 名入组的参与者中（83%为男性，中位年龄 41 岁），55 名（59%）在过去一个月内有注射行为。在 HCV 治疗和随访期间，任何注射吸毒行为均有所减少（每增加一次研究就诊，OR 0.89；95%CI 0.83-0.95）。没有发现≥每日注射（OR 0.98；95%CI 0.89-1.07）、使用非无菌针头（OR 0.94；95%CI 0.79-1.12）、共用注射用具（OR 0.87；95%CI 0.70-1.07）或非注射药物使用（OR 1.01；95%CI 0.92-1.10）的显著变化。危险饮酒行为在整个过程中减少（OR 0.56；95%CI 0.40-0.77），OST 在入组和治疗结束之间增加（OR 1.48；95%CI 1.07-2.04）。
结论
在正在接受注射吸毒的参与者中，在 HCV 治疗期间和治疗后，最近的注射吸毒和危险饮酒行为减少，而 OST 增加。这些发现支持在 PWID 中进一步扩大 HCV 护理。
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