Treating Chronic Hepatitis C with Pegylated Interferon and Ribavirin Between the Incarcerated and the Community Patients

長效干擾素併雷巴威靈治療受刑人慢性C型肝炎與社區病人之比較

林連豐(Lian-Feng Lin) ； 詹益群(Yi-Chun Chan) ； 阮盛豪(Seng Howe Nguang)

《內科學誌》 28卷1期 (2017/02) Pp. 33-40

https://doi.org/10.6314/JIMT.2017.28(1).06

摘要

To investigate the use of pegylated interferon 2a plus ribavirin (Peg-Riba) for treating the incarcerated HCV patients compared to HCV patients from community. A retrospective study was conducted to compare the Peg-Riba therapy between the community and the incarcerated HCV patients. Cirrhosis, hepatoma, experienced therapy, HIV/HBV and complicated comobidity were excluded. The SVR rate was the primary outcome measure and the demographic parameters, biochemistry, HCV genotype, adverse effects, withdrawal rate and lost-to-follow-up rate were measured as the secondary outcomes. A total of 215 male HCV patients were enrolled, of which 103 were incarcerated patients and 112 were from the community. The incarcerated patients were younger (39.3 ± 5.9 vs 49.3 ±12.3 years), had less genotype 1b (17% vs 54%), higher viral load (5.98 ± 0.73 vs 5.35 ± 1.17 Log_(10) IU/mL), and higher Alanine aminotransferase (ALT) (97 ± 50 vs 127±79 IU/L). While on treatment, the incarcerated HCV patients experienced more skin side effects and lower RVR rate (70.9% vs 75.9%, p=0.001), however no difference in the withdrawal rate due to side effects was observed. After treatment, higher SVR was observered in the incarcerated patients regardless of per-protocol (95.2% vs 73.7%, p=0.000) and intention-to-treat analysis (82.5% vs 62.5%, p=0.001). The lost-to- follow-up rate due to prison transfer and early release in the incarcerated patients was not rare. Peg-Riba therapy in the incarcerated HCV patients achieved excellent SVR about 95.2%. It should be a golden time to eradicate HCV during the inmates staying in the facility.

關鍵字

Chronic hepatitis C ； Correctional facility ； Incarcerated ； Pegylated interferon

並列摘要

自從2013實施二代健保以來，罹患慢性C型肝炎之受刑人得以接受治療。本研究是國內首次比較長效干擾素併雷巴威靈治療受刑人與社區病人之臨床結果。自2005-2015本院登錄慢性C肝治療計畫有530例－包含肝炎特診進駐矯正機關治療受刑人。採回溯分析同性別，使用相同廠牌干擾素，排除肝硬化，肝癌，治療過，合併HIV或HBV，複雜合併症者。比較兩組人口學特徵，檢驗值，病毒量，治療中斷，追蹤中斷，RVR，與治療後SVR為比較結果。共有103位接受治療之男性受刑人與112位社區接受治療之中壯年男性病患收入分析比較。受刑人組皆有毒癮史，年紀較輕（39.3 ± 5.9 vs 49.3 ± 12.3歲），治療前較少1b基因型（17% vs 54%），較高C肝病毒量（5.98 ± 0.73 vs 5.35 ± 1.17 Log_(10)）與較高GPT（97 ± 50 vs 127 ± 79IU/L）。治療中超過半數患者有皮膚癢/皮膚疹之副作用，較低快速病毒反應率（RVR）（70.9% vs 75.9%, p = 0.001），因副作用而中斷治療無差異，治療成功率明顯優於社區組（Per-protocol SVR 95.2% vs 73.7%, p=0.000. Intention-to-treat SVR 82.5% vs 62.5%, p = 0.001）。然而因提早出獄或轉獄而無法完成追蹤者也不少。進駐矯正機關治療C肝受刑人是可行與安全的模式，治癒率可達95%。對於因毒癮感染C肝之患者，在矯正機關服刑期間不失為一治療良機，因為治療服從性高，效果好。但是監獄與監獄，或監獄與社區醫院必須合作提供整合性的追蹤照顧。