大眾支持普及C型肝炎篩檢


  【24drs.com】根據線上版BMC傳染病期刊(BMC Infectious Diseases)的一篇新研究指出,病患支持普及C型肝炎(HCV)感染篩檢,即便原本沒有陰性結果者也是如此。
  
  美國約有290萬至370萬人感染HCV,其中約70%不知情,感染者有20%到30%會惡化為肝硬化;HCV是肝臟移植病患最常見的肝衰竭原因。
  
  目前的治療約可有50%治癒率,廣泛實施可降低HCV併發症達16%至42%。
  
  目前的篩檢指引建議醫師在病患有1個以上風險因素時進行篩檢,這些因素如:使用注射藥物(通常指毒品)、在1992年前接受過輸血、肝功能指數上升;不過,這類篩檢有點複雜,因為病患可能不會承認以前的藥物濫用行為,也有其他限制,例如,未掌握其他可能的風險因素,如遠端醫原性傳染。
  
  為了估計大眾對HCV篩檢計畫的意見,華盛頓大學過敏與感染科的Phillip O. Coffin醫師等研究者在2010年8月於西雅圖一個主要都會區醫學中心的5個門診診所進行了一項調查,回覆率為85.8%(調查233名病患,有200人回覆),研究對象的年齡中位數是47歲,女性佔55.3%,白人為56.3%、黑人32.7%,9.5%表示曾檢測HCV陽性,2.5%表示曾檢測HIV陽性。
  
  這項調查包括3個選項:未曾檢查過或以前檢查為陰性者也全面檢測(48%選這項);有機會排除時檢測、且之前無陰性結果 (37%選這項);根據臨床判斷檢測(15%選這項)。
  
  研究限制包括,缺乏研究對象的一般情況與疾病資訊,並非每個研究對象都被問相同問題,影響到比較性,此外,這是量化而非質性分析,因此也會影響結果。
  
  作者們結論表示,病患將接受檢測列為第一優先,而不是考量知情同意或陰性結果,醫師、公衛官員和臨床風險評估者應將這些結果視為優先事項。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6552&x_classno=0&x_chkdelpoint=Y
  

Public Supports Universal Hepatitis C Screening

By Jim Kling
Medscape Medical News

June 20, 2011 — A new study indicates that patients support universal screening for hepatitis C virus (HCV) infection, even in the absence of prior consent or communication of negative results. The study was published online June 6 in BMC Infectious Diseases.

Between 2.9 and 3.7 million people in the United States are infected with HCV, and about 70% are unaware of it. Between 20% and 30% of the infected patients will go on to develop cirrhosis. HCV is the most common cause of liver failure among liver transplant patients.

Current therapies achieve about a 50% cure rate, and broad implementation could reduce HCV complications by 16% to 42%.

Current screening guidelines direct physicians to screen patients when they have one or more risk factors, such as injected drug use, having received a blood transfusion before 1992, or elevated liver function tests. However, such screening is complicated because patients may not admit to past behaviors such as drug abuse, among other limitations, including not capturing other potential risk factors such as possible remote iatrogenic transmission.

To gauge the public's opinion on potential HCV screening programs, in August 2010 the researchers, led by Phillip O. Coffin, MD, MIA, from the Division of Allergy and Infectious Diseases, University of Washington, Seattle, conducted a survey at 5 outpatient clinics of a major public urban medical center in Seattle. The response rate was 85.8% (200 responses of 233 patients surveyed). The study group had a median age of 47 years and included 55.3% women. Of the participants, 56.3% were white, 32.7% were black, 9.5% said they had been tested positive for HCV, and 2.5% reported testing positive for HIV.

The survey included 3 options: universal testing without being informed of the test or being told of negative results (48% preferred this option); testing with an opportunity to opt out, and without being informed of negative results (37% preferred); and testing based on clinician judgment (15% preferred).

Limitations of the study include the lack of both generalizability and disease confirmation status reported by the participants. In addition, the respondents were not asked all of the same questions, which limited comparisons. This was also a quantitative, not qualitative, analysis, which may alter results.

"[P]atients appear to place a higher priority on being tested than they do on the process of informed consent or the receipt of negative results. These findings should inform the priorities of clinicians, public health officials, and clinical risk managers," the authors conclude.

Dr. Coffin’s work is supported by a grant from the National Institute of Allergy and Infectious Diseases. The authors have disclosed no relevant financial relationships.

BMC Infect Dis. Published online June 6, 2011. Full text

    
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