Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain.
Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain.
World J Gastroenterol. 2020 Oct 14;26(38):5874-5883. doi: 10.3748/wjg.v26.i38.5874.
Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine.
To assess HCV treatment rates in an Opioid Treatment Program (OTP).
This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors.
Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive ( = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80).
HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.
对于接受美沙酮或丁丙诺啡治疗的丙型肝炎病毒 (HCV) 感染患者，推荐使用直接作用抗病毒药物 (DAA) 进行治疗。
评估阿片类药物治疗计划 (OTP) 中的 HCV 治疗率。
这项纵向研究纳入了 2015 年 10 月至 2017 年 9 月间入组 OTP 的 501 例患者（81.4%为男性，中位年龄：45 岁；四分位间距：39-50 岁）。患者随访至 2019 年 9 月。入组时收集了社会人口统计学、物质使用、HCV 感染、人类免疫缺陷病毒 (HIV) 感染和实验室参数等数据。我们分析了病历以评估 HCV 治疗情况。采用 Kaplan-Meier 方法和 Cox 回归模型分析 DAA 治疗的接受情况，并确定治疗预测因素。
HCV 和 HIV 感染的患病率分别为 70%和 34%。在抗-HCV 阳性的 336 例患者中，分别有 47.2%、41.3%和 31.9%使用酒精、大麻和可卡因。233 例（69.3%）患者的 HCV-RNA 检测为阳性。28 例（8.3%）患者清除了感染，59 例（19.1%）在 2015 年之前接受过基于干扰素的治疗方案。在 249 例符合条件的患者中，111 例（44.6%）接受了 DAA。治疗率随时间显著增加，从 2015 年的 7.8/100 人年（95%CI：5.0-12.3）增加到 2019 年的 18.9/100 人年（95%CI：11.7-30.3）。多变量分析显示，HIV 合并感染的患者接受 DAA 的可能性是 HCV 单一感染患者的两倍（HR = 1.94，95%CI：1.21-3.12）。当前药物使用是未接受感染治疗的独立危险因素（HR = 0.48，95%CI：0.29-0.80）。
在 HCV-HIV 合并感染的患者中，HCV 的治疗正在发生演变。在 OTP 中持续药物使用可能会对治疗感染的准备情况产生负面影响。
