Addicts with chronic hepatitis C:Difficult to reach,manage or treat?  

作　　者：Barbara Zanini Federica Benini Marie Graciella Pigozzi Patrizia Furba Ernesto Giacò Antonia Cinquegrana Mariagrazia Fasoli Alberto Lanzini 

机构地区：[1]Department of Clinical and Experimental Sciences, Gastroenterology Unit, University and Spedali Civili of Brescia, I-25123 Brescia, Italy [2]Territorial Addiction Service (SerT), Local Health Authority (ASL) of Brescia, I-25100 Brescia, Italy

出　　处：《World Journal of Gastroenterology》2013年第44期8011-8019,共9页世界胃肠病学杂志（英文版）

摘　　要：AIM:To assess the acceptance,safety and efficacy of care and treatment for chronic hepatitis C(CHC)in drug addicts.METHODS:We designed a multidisciplinary,phase IV prospective cohort study.All illicit drug users(IDUs)visited a Territorial Addiction Service(SerT)in the District of Brescia,and hepatitis C antibody(HCVAb)testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit.Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5μg/kg per week plus ribavirin(800-1400 mg/d)for 16-48wk.All IDUs were unselected because of ongoing addiction and read and signed an informed consent form.Virologic responses at weeks 4 and 12 of therapy,at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy.Adherence was estimated according to the 80/80/80 criteria.RESULTS:From November 2007 to December 2009,162 HCVAb+IDUs were identified.Sixty-seven patients(41%of the initial cohort)completed the diagnostic procedure,and CHC was diagnosed in 54(33%of the total).Forty-nine patients were offered therapy,and 39agreed(80%of acceptance rate).The prevalent HCV genotype was type 1,and the HCV RNA baseline level was over 5.6 log/mL in 61%of cases.Five patients dropped out,two because of severe adverse events(SAEs)and three without medical need.Twenty-three and 14 patients achieved end of treatment responses(ETRs;59%)and sustained virologic responses(SVRs;36%),respectively.Thirty-one patients were fully compliant with the study protocol(80%adherence).The prevalence of host and viral characteristics negatively affecting the treatment response was high:age over40 years(54%),male gender(85%),overweight body type(36%),previous unsuccessful antiviral therapy(21%),HCV genotype and viral load(60%and 62%,respectively),earlier contact with HBV(40%)and steatosis and fibrosis(44%and 17%,respectively).In a univariate analysis,alcohol intake was associated with a non-response(P=0.0018,95%CI:0.0058-0.4565).CONCLUSION:DruAIM: To assess the acceptance, safety and efficacy of care and treatment for chronic hepatitis C (CHC) in drug addicts. METHODS: We designed a multidisciplinary, phase IV prospective cohort study. All illicit drug users (IDUs) visited a Territorial Addiction Service (SerT) in the District of Brescia, and hepatitis C antibody (HCVAb) testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit. Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5 μg/kg per week plus ribavirin (800-1400 mg/d) for 16-48 wk. All IDUs were unselected because of ongoing addiction and read and signed an informed consent form. Virologic responses at weeks 4 and 12 of therapy, at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy. Adherence was estimated according to the 80/80/80 criteria. RESULTS: From November 2007 to December 2009, 162 HCVAb+ IDUs were identified. Sixty-seven patients (41% of the initial cohort) completed the diagnostic procedure, and CHC was diagnosed in 54 (33% of the total). Forty-nine patients were offered therapy, and 39 agreed (80% of acceptance rate). The prevalent HCV genotype was type 1, and the HCV RNA baseline level was over 5.6 log/mL in 61% of cases. Five patients dropped out, two because of severe adverse events (SAEs) and three without medical need. Twenty-three and 14 patients achieved end of treatment responses (ETRs; 59%) and sustained virologic responses (SVRs; 36%), respectively. Thirty-one patients were fully compliant with the study protocol (80% adherence). The prevalence of host and viral characteristics negatively affecting the treatment response was high: age over 40 years (54%), male gender (85%), overweight body type (36%), previous unsuccessful antiviral therapy (21%), HCV genotype and viral load (60% and 62%, respectively), earlier contact with HBV (40%) and steatosis and fibrosis (44% and 17%, respectively). In a univariate analysis, alcohol intak

关 键 词：Chronic hepatitis C ADDICTION ANTIVIRAL therapy INTERFERON Multidisciplinary 

分 类 号：R512.63[医药卫生—内科学]