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首页> 外文期刊>European journal of gastroenterology and hepatology >Adherence to hepatitis C treatment in recovering heroin users maintained on methadone.
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Adherence to hepatitis C treatment in recovering heroin users maintained on methadone.

机译：在恢复美沙酮维持的海洛因使用者中坚持丙型肝炎治疗。

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OBJECTIVES: Injection drug users are often denied hepatitis C (HCV) treatment due to concerns about adherence, despite limited data about the impact of such common issues as psychiatric illness and intercurrent drug use. We sought to define the impact of these and other potential adherence barriers in a real-world sample of recovering drug users. METHODS: We conducted a prospective observational study of 71 methadone-maintained patients who received interferon and ribavirin combination therapy in a community-based clinic with expertise in treating addictive disorders. Adherence measures were conducted with monthly interview, medication counts, and urine toxicology testing. RESULTS: Overall, 48 (68%) were adherent, and adherent patients were significantly more likely to achieve a sustained virologic response (42 vs. 4% in nonadherent patients). Patients with and without a prior psychiatric history were similarly adherent (64 vs. 72%, respectively, P>0.5), and the initiation of new psychiatric medications during HCV treatment was associated with improved adherence overall (P=0.02) and in patients that did not report a preexisting psychiatric diagnosis (P=0.04). Trend towards reduced adherence in patients without a period of abstinence was seen before initiating HCV treatment, 46 vs. 72% of those who had been abstinent for at least 1 month (P=0.10). Although occasional drug users were similarly adherent to those who were completely abstinent, patients who relapsed to regular drug use showed a significantly lower level of adherence (P=0.03). CONCLUSIONS: We conclude that the majority of methadone-maintained drug users can adhere to HCV treatment, even those with psychiatric illness and relatively limited pretreatment drug abstinence. Lack of pre-HCV treatment drug abstinence and regular drug use during HCV treatment may be relative barriers to medication adherence, but the initiation of psychiatric medications during HCV treatment may be a helpful intervention. This report provides further evidence for an individualized approach to HCV treatment that does not categorically exclude patients with potential barriers such as mental illness and limited drug abstinence.
机译：目的：尽管对有关精神疾病和并发吸毒等常见问题的影响的数据有限，但由于担心依从性，注射吸毒者经常被拒绝接受丙型肝炎（HCV）治疗。我们试图定义这些和其他潜在依从性障碍对正在康复的吸毒者的真实样本的影响。方法：我们在社区专门治疗成瘾性疾病的诊所对71名美沙酮维持的接受干扰素和利巴韦林联合治疗的患者进行了一项前瞻性观察研究。坚持措施通过每月的面试，药物计数和尿毒理学测试进行。结果：总体上，有48位（68％）是依从性的，依从性患者获得持续病毒学应答的可能性更高（42％vs. 4％）。有或没有精神病史的患者依从性相似（分别为64％和72％，P> 0.5），在HCV治疗期间开始新的精神科药物与整体依从性改善有关（P = 0.02），并且没有报告先前存在的精神病诊断（P = 0.04）。在开始HCV治疗之前，没有禁欲期的患者依从性降低的趋势已得到观察，其中禁酒至少1个月的患者中有46％vs. 72％（P = 0.10）。尽管偶尔吸毒者对完全戒酒者依从性相似，但复发至常规吸毒的患者依从性明显降低（P = 0.03）。结论：我们得出的结论是，大多数美沙酮维持的吸毒者都可以坚持HCV治疗，即使是那些患有精神疾病和戒毒治疗相对有限的人。 HCV治疗前缺乏戒酒和HCV治疗期间常规用药可能是药物依从性的相对障碍，但是HCV治疗期间开始精神科用药可能是有益的干预措施。该报告为个体化HCV治疗方法提供了进一步的证据，该方法并未明确排除具有潜在障碍（例如精神疾病和禁毒）的患者。

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