慢性C型肝炎病患的療效分析-新竹某醫學中心經驗分享

Evaluation of Therapeutic Effect in Chronic Hepatitis C Treatment-Experience of A Medical Center in Hsin-Chu

目的：探討某醫學中心配合衛生福利部政策、於2015～2024年間執行慢性C型肝炎治療之成效，並進一步統計與第二型糖尿病、HIV感染者及靜脈非愛滋藥癮共病族群之治療狀況與預後追蹤，希可提供臨床後續更有效診治及建議。方法：本研究經倫理審查核可，採回溯性病歷檢閱方式，逐一查閱統計共1，289例標準慢性C肝治療個案之療效及預後回診追蹤。結果：干擾素治癒率54.0％，其中困難治療改直接抗病毒藥物（Direct-acting Antiviral，DAA）、合併單純DAA治療者，總計DAA整體治癒率98.7％。後續追蹤治療成功個案共1，258例，達持續性病毒反應後1年回診率70.8％，且最長10年無復發。共病族群以第二型糖尿病者佔23.0％最高；其次為人類免疫缺乏病毒感染者／靜脈注射藥癮者，此族群有個案因持續注射最多共感染3次。結論：建議藥癮共病者可治療並行戒毒；共病族群有較高的第二型糖尿病分佈比例。整體而言，配合國家政策提升C肝治療涵蓋率，有助達到消除C肝的預期目標。

Objectives. To evaluate the effectiveness of chronic hepatitis C (CHC) treatment implemented at our hospital from 2015 to 2024 in alignment with Ministry of Health and Welfare (MOHW) policy, and to describe treatment status and prognostic follow-up in patients with comorbid type 2 diabetes mellitus (T2DM), human immunodeficiency virus (HIV) infection, and intravenous drug user (IDU) without HIV infection.
Methods. This ethics committee–approved retrospective chart review included 1,289 patients who received standard CHC therapy. Treatment response and post-treatment clinic follow-up were analyzed.
Results. The sustained virologic response (SVR) rate with interferon-based therapy was 54.0%. Among difficult-to-treat patients who switched to direct-acting antivirals (DAAs), together with those treated with DAAs alone, the overall SVR rate of DAA therapy was 98.7%. Of 1,258 patients achieving SVR, the 1-year follow-up rate was 70.8%, and no relapse was observed for up to 10 years. T2DM was the most common comorbidity (23.0%), followed by HIV infection and PWID without HIV infection. In the PWID without HIV infection group, one patient had three documented reinfections, concurrent with continued injection drug use.
Conclusion. Substance cessation could be concurrent with medication for patients with injection drug use–related comorbidity. Genotype 2 was more prevalent among comorbid populations. Expanding CHC treatment coverage in accordance with national policy may facilitate hepatitis C elimination.