美沙酮維持計畫可減少C型肝炎比率


  【24drs.com】April 19, 2010 (舊金山) — 一篇有關美沙酮維持治療對象之C型肝炎(HCV)感染的研究發現,增添了證據顯示,物質濫用治療不只對藥癮有效,也可降低感染症的風險。
  
  以色列特拉維夫Sourasky醫學中心Miriam暨Sheldon G. Adelson醫師藥癮治療與研究中心的研究者,在美國成癮醫學會(ASAM)第41屆醫學科學年會中發表指出,於1993至2008年在特拉維夫診所住院的207個HCV-陰性病患中,只有25人變成HCV陽性,相當於每追蹤100人年有2.2例,病患接受至少2次的HCV檢查,並追蹤直到他們的第二次檢測或血清轉化。
  
  第一研究者、Einat Peles博士向Medscape Psychiatry表示,在我們的研究中,變成C型肝炎的血清轉化率偏低,我們希望的就是這樣。
  
  研究者也檢視了C型肝炎血清轉化的風險因素,Peles博士表示,C型肝炎血清轉化最強的預測風險因素是注射藥物使用者、住院使用benzodiazepine者、再度加入美沙酮維持計畫者。
  
  在使用注射藥物的118名病患中,血清轉化率顯著較高,有103名病患因為benzodiazepine尿液檢測陽性而住院使用美沙酮維持治療,其中43人退出治療後再度加入。
  
  Peles博士表示,根據研究,需要對這些高風險族群進行特定介入,以減少血清轉化風險,這些介入方式包括長期成癮藥物治療、監測 HCV。
  
  【終生的疾病】
  明尼拿坡里市明尼蘇達大學醫學院醫學助理教授、Hennepin郡醫學中心成癮醫療小組主任Gavin Bart醫師建議,成癮是一種慢性的終生疾病,需要終生的藥物治療 — 不只治療藥癮,還可預防C型肝炎等感染。
  
  Bart醫師是ASAM會議主席,同時也主持以色列研究發表時的小組會議,他在Medscape Psychiatry的訪問中表示,這是相當重要的研究,因為它顯示,治療不僅對成癮有效,還可預防C型肝炎。Bart醫師指出,該研究也支持繼續監測,或者立即篩檢那些有血清轉化成C型肝炎風險者,例如持續使用藥物者。
  
  該研究中,Peles博士與Miriam Adelson醫師發現,使用注射藥物者的風險比為3.9 (P = .002),再度接受美沙酮維持治療者為2.5 (P = .03)、濫用benzodiazepine者為3.4 (P = .009)。
  
  Peles博士表示,女性、30歲以下者、B型肝炎陽性者的血清轉化風險傾向較高,她指出,美沙酮劑量不是血清轉化成C型肝炎的風險因素,有小孩似乎可預防血清轉化。
  
  Bart醫師指出,在以色列,benzodiazepines可能成為最常被濫用的藥物,當地的物質濫用診所發現,古柯鹼濫用的情況並沒有像美國那樣。
  
  【篩檢感染症的訊號】
  他表示,C型肝炎血清轉化的風險因素並不只有使用benzodiazepine,讓人們處於風險的是持續濫用藥物的行為,對物質濫用諮商者而言,持續濫用藥物 — 不論這些是否是注射藥,如海洛因 — 都是一個警訊,應建議這些病患接受感染症(如HCV、B型肝炎和HIV)篩檢。
  
  Bart 醫師表示,但重點是,以色列研究中,血清轉化成C型肝炎的比率偏低,證實了美沙酮維持治療等藥物成癮治療的效果。
  
  他指出,注射藥物使用者中,C型肝炎比率高達60%-90%,所以,知道哪些接受治療者比較少發生C型肝炎的確是個好消息。
  
  Peles博士和Bart醫師都宣告沒有相關財務關係。
  
  美國成癮醫學會(ASAM)第41屆醫學科學年會:摘要3,發表於2010年4月16日。

Methadone Maintenance Programs May Reduce Rates of Hepatitis C

By Barbara Boughton
Medscape Medical News

April 19, 2010 (San Francisco, California) — Findings from a new study on hepatitis C (HCV) infection among individuals in methadone maintenance treatment add to the growing body of literature that shows that substance abuse treatment is effective not only for drug addiction but also for reducing risk for infectious disease.

Presented here at the American Society of Addiction Medicine (ASAM) 41st Annual Medical-Scientific Conference, investigators at the Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research at the Tel Aviv Sourasky Medical Center in Israel found that among 207 HCV-negative patients admitted to the Tel Aviv clinic between 1993 and 2008, only 25 patients became HCV positive or 2.2 per 100 person-years of follow-up. Patients with at least 2 tests for HCV were followed up until their second test or seroconversion.

"The rate of seroconversion to hepatitis C we found in our study was low, and we hope it will stay that way," lead researcher Einat Peles, PhD, told Medscape Psychiatry.

The investigators also examined the risk factors for hepatitis C seroconversion. Those risk factors that were the strongest predictors of HCV seroconversion were having been an injection drug user, benzodiazepine use on admission, and readmission to the methadone maintenance program, said Dr. Peles.

The seroconversion rate was significantly higher among the 118 patients who had been drug injectors, for the 103 patients with a urine test result positive for benzodiazepine use on admission to methadone maintenance, and among 43 patients who left treatment and then were readmitted.

"Specific interventions may be needed to reduce the risk of seroconversion among these high-risk groups,” Dr. Peles said. These interventions might include long-term medication treatment for addiction and monitoring for HCV, according to researchers here.

Lifelong Disease

"Addiction is a chronic, lifelong disease that may require lifelong medication — not just to treat the addiction but also to prevent infections such as hepatitis C," commented Gavin Bart, MD, director of the Division of Addiction Medicine at the Hennepin County Medical Center and assistant professor of medicine at the University of Minnesota Medical School, Minneapolis.

Dr. Bart chaired the ASAM meeting and moderated the session at which the Israeli study was presented. "This is a very important study because it shows that not only does treatment work for the addiction itself but is a preventive measure for hepatitis C," he said during an interview with Medscape Psychiatry. Dr. Bart added that that the study also supports continued monitoring or intermittent screening of those with risk factors for seroconversion to hepatitis C, such as continued drug use, he said.

In the study, Peles and fellow researcher Miriam Adelson, MD, found that the hazard ratio for being a drug injector was 3.9 (P = .002), for readmission to methadone maintenance treatment was 2.5 (P = .03), and for benzodiazepine abuse was 3.4 (P = .009).

There was also a trend toward greater risk for seroconversion among those who were female, those younger than 30 years, and those positive for hepatitis B, Dr. Peles said. She noted that methadone dose was not a risk factor for seroconversion to hepatitis C, and having children seemed to protect against seroconversion.

Dr. Bart pointed out that benzodiazepines tend to be a commonly abused drug in Israel, and substance abuse clinics there do not see the same prevalence of cocaine drug abuse as in the United States, for instance.

Signal for Infectious Disease Screening

"The risk factor for hepatitis C seroconversion isn’t specific to benzodiazepine use. The behavior that puts people at risk is ongoing drug use," he said. Continued abuse of drugs — whether or not these drugs are injectable drugs, such as heroin — may be a signal to substance abuse counselors to recommend that these patients undergo screenings for infectious diseases, such as HCV, hepatitis B, and HIV, he said.

But all in all, the low rate of seroconversion to hepatitis C seen in the Israeli study is a validation of drug addiction treatments, such as methadone maintenance, Dr. Bart said.

"Hepatitis C is a huge epidemic among infection drug users with rates of 60% to 90%. So it’s good to know that those who get treatment are less likely to go on to get hepatitis C," he added.

Dr. Peles and Dr. Bart have disclosed no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 41st Annual Medical-Scientific Conference: Abstract 3. Presented April 16, 2010.

    
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