中台灣美沙冬替代療法個案人類免疫缺陷病毒感染、B型肝炎感染及C型肝炎感染盛行率

Prevalence of HIV, Hepatitis B, Hepatitis C in Patients Participating in the Methadone Maintenance Treatment in Central Taiwan

背景：人類免疫缺陷病毒、B 型肝炎病毒及 C 型肝炎病毒的傳播在海洛因依賴個案中是 很重要的議題。 目的：這個研究是在研究人類免疫缺陷病毒、B 型肝炎病毒及 C 型肝炎病 毒的傳播在海洛因依賴個案的盛行率，及分析相關因子，這些個案是從 2007 年 1 月到 2011 年 2 月間加入美沙冬替代治療的個案。方法：這是一個回顧性的研究，收集中台灣彰基及彰 基鹿東分院新加入美沙冬替代治療的個案。 方法： 這是一個回顧性的研究，收集中台灣彰基及彰基鹿東分院新加入美沙冬替代治療的個案。 結果： 研究納入 1149 名個案，包括 1012 位男性 (88.1%) 及 137 位女性 (11.9%)，其中 232 位個案 (20.2%) 有人類免疫缺陷病毒抗體陽性，546 位個案 (47.5%) 有 B 型肝炎表面抗體陽性，335 位個案 (29.2%) 有 B 型肝炎感染，982 位個案 (85.5%) 有 C 型肝炎感染，而 C 型肝炎感染者中包括 757 位 (82.6%) 非人類免疫缺陷病毒感 染，及 225 位 (97.0%) 人類免疫缺陷病毒帶原者。靜脈注射與 C 型肝炎感染有顯著關係，另 外發現 C 型肝炎感染者，有較高的麩氨基酸草醋酸轉氨基酵素與麩氨基酸焦葡萄轉氨基酵 素，較年輕就使用海洛因，較多次戒毒經驗，及較長的海洛因使用期間。而男性、靜脈注射 者、較低學歷、無業及 C 型肝炎感染者與人類免疫缺陷病毒感染有統計相關，人類免疫缺 陷病毒感染個案有較高麩胺轉酸脢，年紀較大，較多次戒毒經驗，及較長的海洛因使用期間。 結論： 這群個案應更密及追蹤其病毒感染狀況，早期予以介入治療，進一步研究 C 型 肝炎及人類免疫缺陷病毒共同感染是必要的。

Objective: Transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are important issues in heroin addicts. In this study, we investigated the prevalences of HIV, HBV, and HCV infections and analyzed the associations between relative factors in heroin addicts, who were enrolled in the methadone maintenance treatment (MMT), in central Taiwan from January 2007 to February 2011. Method:： This is a retrospect study. We reviewed the medical records of subjects enrolling in the MMT in Changhua Christian Hos- pital, a medical center, and Lu tung Branch of Changhua Christian Hospital, a psychiatric subspecialty hospital, in central Taiwan. Results: We enrolled 1,149 subjects, including 1,012 male subjects (88.1%) and 137 female subjects (11.9%). We found that 232 subjects (20.2%) had HIV, 546 subjects (47.5%) HBsAb-posi- tive, and 335 subjects (29.2%) hepatitis B-positive status. A total of 982 subjects (85.5%) was found to have hepatitis C infection, including 757 non-HIV subjects (82.6%) and 225 HIV carriers (97.0%). We found that there was significant rela- tionship between intravenous injection and HCV-positive status (p< 0.001). Sub- jects with HCV-positive status had significantly higher GOT (p< 0.05), higher GPT (p< 0.001), younger age of heroin first time using (p< 0.001), more absti- nence heroin times (p< 0.001), and longer heroin using duration (p< 0.001). Male (p< 0.05), intravenous injection user (p< 0.001), lower education level (p< 0.05), unemployment status (p< 0.05), and HCV infection were related with HIV-posi- tive status. Subjects with HIV positive status also had significant higher mean of γ-GT (p< 0.05), older age (p< 0.05), times of heroin abstinence (p< 0.05), and heroin using duration (p< 0.001). Conclusion: This population should be closely followed for their infection condition, and receive effective intervention more ear- ly. Further basic or clinical studies for co-infection of HCV and HIV are needed.