云南省芒市美沙酮维持治疗门诊服药者HCV感染及治疗现状分析

HCV Infection and Treatment Status among Methadone Maintenance Treatment Clinic Patients in Mangshi,Dehong Prefecture,Yunnan

目的了解芒市美沙酮维持治疗(MMT)门诊服药者HCV感染率以及治疗情况,为HCV的防治提供依据。方法采用横断面调查,2018年10月,抽取芒市MMT门诊服药者静脉血5 mL,用ELISA法检测HCV抗体。对HCV抗体阳性者进行问卷调查、HCV病毒载量及基因亚型检测。结果共调查239名MMT门诊服药者,HCV抗体阳性188例(78.7%),HCV/HIV合并感染105例(43.9%)。年龄>35岁、未婚/离异/丧偶、职业为待业和小业主、有注射吸毒史、有共用针具史、HIV阳性的MMT服药者的HCV抗体阳性率更高,与HCV抗体阴性者相比差异存在统计学意义(P<0.05)。其中144例研究对象进行了HCV病毒载量和基因亚型检测,98例(68.1%)HCV病毒载量在检测限以上,43例(29.9%)进行过丙肝抗病毒治疗。101例(70.1%)未治疗者主要由于经济困难或自觉症状较轻。高中及以上教育程度、职业为其他、HIV阳性、HCV病毒载量水平低的MMT服药者HCV治疗率更高,与未治疗者相比差异有统计学意义(P<0.05)。97例拼接成功者,基因亚型以3 b为主32例(33.0%),6 n、1 a和其他分别为22例(22.7%)、18例(18.6%)和25例(25.8%)。结论芒市MMT门诊HCV抗体阳性率、HCV/HIV合并感染率均较高,但丙肝治疗率不足30%。提示应采取措施提高该人群的丙肝治疗率,以降低丙肝相关疾病负担和死亡。

Objective To investigate the prevalence of HCV infection and its treatment status among people receiving methadone maintenance treatment(MMT),aiming to provide evidence for further development of HCV prevention and treatment strategies.Methods During October 2018,a cross-sectional survey was conducted among patients in the MMT clinic in Mangshi,Yunnan Province.All participants were taken 5 mL venous blood to test HCV antibodies by ELISA.HCV antibody positive MMT patients were further interviewed by questionnaires and tested for HCV RNA including subtypes.Results Of 239 MMT patients enrolled,188(78.7%)were positive for HCV antibody.105(43.9%)were co-infected with both HIV and HCV.There were statistically significant differences in age,marital status,occupation,injecting drugs,experience of needle sharing,and HIV infection status among MMT patients with positive or negative HCV antibody(P<0.05).Of 144 patients who were tested for HCV RNA with subtypes,68.1%had HCV RNA above the detection level and 29.9%were treated with anti-HCV drugs.The main reason for not receiving HCV treatment were financial difficulties or having mild symptoms.Those who were with a high school education or above,HIV-positive,and a lower level of HCV RNA were significantly more likely to receive the anti-HCV therapy.There were statistically significant differences in age,education,occupation,HIV infection status,and HCV RNA levels among patients with and without the anti-HCV treatment(P<0.05).The main HCV subtypes in our study patients were 3b(33.0%),6n(22.7%),and 1a(18.6%).Conclusion The prevalence of HCV infection and even HCV/HIV coinfection were found to be high among MMT clinic patients in Mangshi.However,the HCV treatment rate was less than 30%among these patients,indicating more efforts are needed to increase the HCV treatment among MMT patients with HCV infection to further reduce the HCV burden and its associated mortality.