{"id":1746,"date":"2003-10-01T01:00:00","date_gmt":"2003-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/influence-de-lusage-actif-de-drogues-sur-la-qualite-de-la-prise-en-charge-de-lhepatite-c-experience-dun-service-dhepatologie-prenant-en-charge-les-addictions\/"},"modified":"2018-10-20T18:39:30","modified_gmt":"2018-10-20T16:39:30","slug":"influence-de-lusage-actif-de-drogues-sur-la-qualite-de-la-prise-en-charge-de-lhepatite-c-experience-dun-service-dhepatologie-prenant-en-charge-les-addictions","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/influence-de-lusage-actif-de-drogues-sur-la-qualite-de-la-prise-en-charge-de-lhepatite-c-experience-dun-service-dhepatologie-prenant-en-charge-les-addictions\/","title":{"rendered":"INFLUENCE DE L\u2019USAGE ACTIF DE DROGUES SUR LA QUALITE DE LA PRISE EN CHARGE DE L\u2019HEPATITE C :\n\n\nEXPERIENCE D\u2019UN SERVICE D\u2019HEPATOLOGIE PRENANT EN CHARGE LES ADDICTIONS"},"content":{"rendered":"

2003<\/strong><\/p>\n

Andr\u00e9 GLIBERT (1), Maxime COURNOT (2), Fabienne CASTEL (1), Fran\u00e7ois DRUART(1), Kamran IMANI (1) , Val\u00e9rie LAUWERS-CANCES (2) Thierry MORIN (1).
\n(1) Service d’h\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier de tarbes
\n(2)D\u00e9partement d’\u00e9pid\u00e9miologie, INSERM U558 Toulouse<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02003-05-19 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

OBJECTIF : Les recommandations actuelles sur le traitement de l\u2019h\u00e9patite C sont en faveur d\u2019indications th\u00e9rapeutiques larges chez les usagers de drogues. Cependant, les r\u00e9ticences \u00e0 traiter les usagers de drogues par voie intraveineuse actifs (UDIVA) sont encore fr\u00e9quentes. Le but de ce travail \u00e9tait de comparer d\u2019une part les caract\u00e9ristiques de l\u2019infection par le VHC en fonction du mode de contamination et d\u2019autre part, la compliance des UDIVA, dans la prise en charge de l\u2019h\u00e9patite C et la r\u00e9ponse au traitement, \u00e0 celle des sujets ne consommant pas ou plus de drogues. <\/p>\n

METHODE : 435 patients s\u00e9ropositifs pour l\u2019h\u00e9patite C ont \u00e9t\u00e9 inclus de 1990 \u00e0 2000 et suivis r\u00e9trospectivement pendant une dur\u00e9e moyenne de 2,5 ans ( 1 an ), 116 d\u2019entre eux (27 %) \u00e9taient UDIVA \u00e0 l\u2019inclusion. Des donn\u00e9es d\u00e9mographiques, sociales, cliniques, biologiques et histologiques on \u00e9t\u00e9 recueillies. Les diff\u00e9rentes \u00e9tapes de la prise en charge de l\u2019h\u00e9patite C et les r\u00e9ponses au traitement \u00e9ventuel ont \u00e9t\u00e9 enregistr\u00e9es et compar\u00e9es parmi les UDIVA et les non-UDIVA. <\/p>\n

RESULTATS : Les 255 patients contamin\u00e9s par usage de drogues par voie intraveineuse en comparaison avec les 210 patients contamin\u00e9s par une autre voie \u00e9taient, de mani\u00e8re significative, plus jeunes, plus souvent des hommes, pr\u00e9sentaient une forte pr\u00e9valence de difficult\u00e9s sociales s\u2019ils \u00e9taient UDIVA (75 % sans emploi fixe, 43 % sans logement fixe), \u00e9taient plus souvent porteurs de g\u00e9notype 3, avaient un score moyen de fibrose (METAVIR) plus bas, un pourcentage identique d\u2019\u00e9limination spontan\u00e9e du VHC.
\n Nous n\u2019avons pas montr\u00e9 de diff\u00e9rence significative entre les UDIVA et les non-UDIVA dans les crit\u00e8res de compliance \u00e0 la prise en charge : recherche de l\u2019ARN viral (85 % versus 67 %), r\u00e9alisation d\u2019une biopsie h\u00e9patique lorsqu\u2019elle \u00e9tait indiqu\u00e9e (82 % versus 87%), mise en route du traitement (33,6 % versus 43,2 %), taux de perdus de vue durant le traitement (14 % versus 10 % ).
\n Le taux de R\u00e9ponse Virale Soutenue (RVS) des UDIVA n\u2019\u00e9tait pas significativement diff\u00e9rent de celui des non- UDIVA (29 % dans les 2 groupes). En analyse multivari\u00e9e, les facteurs ind\u00e9pendants associ\u00e9s \u00e0 une RVS \u00e9taient le sexe f\u00e9minin (OR = 5,6), le g\u00e9notype 3 (OR = 29,7) une charge virale < 2 x 10 puissance 6 copies\/ml par m\u00e9thode bDNA (OR = 33,3 ), un degr\u00e9 de fibrose bas (OR = 1,4) un taux de transaminases sup\u00e9rieur \u00e0 2 N (OR = 12,7), un traitement par bith\u00e9rapie (OR = 10). <\/p>\n

CONCLUSION :
\nDans cette \u00e9tude, l\u2019usage actif de drogues par voie intraveineuse ne constitue pas un obstacle \u00e0 une prise en charge de l\u2019h\u00e9patite C et \u00e0 une r\u00e9ponse optimale au traitement. Pour cela, il est n\u00e9cessaire qu\u2019une \u00e9quipe pluri-disciplinaire propose une offre de soins adapt\u00e9e \u00e0 chaque patient, concernant simultan\u00e9ment les addictions et l\u2019infection par le virus de l\u2019h\u00e9patite C.<\/p>\n","protected":false},"excerpt":{"rendered":"

2003 Andr\u00e9 GLIBERT (1), Maxime COURNOT (2), Fabienne CASTEL (1), Fran\u00e7ois DRUART(1), Kamran IMANI (1) , Val\u00e9rie LAUWERS-CANCES (2) Thierry MORIN (1). (1) Service d’h\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier de tarbes (2)D\u00e9partement d’\u00e9pid\u00e9miologie, INSERM U558 Toulouse H\u00e9patologie – \u00a02003-05-19 –\u00a0CO – ________________________________ OBJECTIF : Les recommandations actuelles sur le traitement de l\u2019h\u00e9patite C sont en faveur d\u2019indications […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[14],"class_list":["post-1746","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-14"],"yoast_head":"\nINFLUENCE DE L\u2019USAGE ACTIF DE DROGUES SUR LA QUALITE DE LA PRISE EN CHARGE DE L\u2019HEPATITE C : EXPERIENCE D\u2019UN SERVICE D\u2019HEPATOLOGIE PRENANT EN CHARGE LES ADDICTIONS - 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