Treatment of Non-cirrhotic Incarcerated Genotype 6 Chronic Hepatitis C Injection Drug Users, Compared with Genotype 1

靜脈注射藥癮受刑人C型肝炎第六型之治療效果，與第一型之比較

林連豐(Lian-Feng Lin) ； 詹益群(Yi-Chun Chan) ； 阮盛豪(Seng-Howe Nguang) ； 李青長(Ching-Chang Lee)

《內科學誌》 29卷6期 (2018/12) Pp. 393-400

https://doi.org/10.6314/JIMT.201812_29(6).06

摘要

The experience of treatment for hepatitis C virus genotype 6 (HCV-6) was limited in Taiwan due to rare incidence in general population and lack of medical care in the correction facilities where HCV-6 was endemic. This work was to investigate the response of treating HCV-6 incarcerated injection drug users (IDU), compared with HCV-1 incarcerated IDUs. 106 inmates completed treatment and follow-up (39 HCV-6, 67 HCV-1, cirrhosis or co-infection with hepatitis B virus or human immunodeficiency virus excluded) were enrolled in this retrospective study among 182 registered peginterferon/ribavirin therapies of National Health Insurance (NHI) reimbursement in the Kaohsiung and Pingtung correcting facilities from 2014 to 2017. Among the 67 HCV-1 and 39 HCV-6 patients, there was no difference with regard to patient’s demographics, hemogram, baseline HCV viral load, except for a higher alanine aminotransferase (ALT) level in HCV-6 patients than HCV-1 patients. Afterword, a higher rapid viral response (RVR) was noted in HCV-6 (64% vs 41%, p=0.018), the sustained viral response (SVR) in HCV-6 or HCV-1 patients who received at least one dose of treatment and the patients who completed the full course of treatment were comparably excellent, (100% vs 89%, p=0.16) and (100% vs 91%, p=0.19) respectively. Although interferon-free direct acting antiviral agents (DAA) are the mainstay of therapy in the world, the peginterferon/ribavirin may be an alternative option for the incarcerated IDU patients with HCV-1 or HCV-6 infection, based on the excellent SVR rate and the limited governmental support for DAA treatment.

關鍵字

Hepatitis C ； Incarcerated ； Inmates ； Jailed ； Peginterferon

並列摘要

在台灣，第6型C型肝炎(HCV-6)少見於社區患者，然而在靜脈注射藥癮受刑人C型肝炎中約有28%是第六型，因為矯正機關缺乏醫療照護，故國內第6型的治療經驗有限。自2013二代健保開始惠及受刑人之醫療照護，直到2017年底於高雄與屏東矯治機關，共有182位受刑人接受長效型干擾素併用雷巴威靈治療C型肝炎---HCV-1a, HCV-1b, HCV-6與其他型（2，3或mixed 感染）之佔比分別29.6%, 24.1%, 24.7%, 與21.4%。扣除第2，3型或混和型，與仍在治療追蹤者，共有39位HCV-1與67位HCV-6共106位靜脈注射藥癮受刑人納入研究比較，本研究採回溯性分析HCV-1與HCV-6兩組人口學特徵，檢驗值，病毒量，治療後結果SVR；HCV-1與HCV-6皆為男性，皆靜脈注射藥癮者，年齡，體重，白血球數，血色素，血小板數，肌酐酸與病毒量，兩組無差異。雷巴威靈劑量，中斷率，兩組無差異，但HCV-6有較佳快速病毒反應RVR，與高病毒清除率。第6 型C型肝炎受刑人干擾素治療之療效，如同文獻報告極優，不亞於第1型。觀之國內受刑人C型肝炎以第1，6型為主，加上兩型干擾素治療SVR相當高，以及醫療費用考量DDA無法應用，故在接受矯正服刑期間干擾素不失為治療C型肝炎的良方。