HCV screening in a cohort of HIV infected and uninfected homeless and marginally housed women in San Francisco, California.
HCV screening in a cohort of HIV infected and uninfected homeless and marginally housed women in San Francisco, California.
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DOI：
10.1186/s12889-017-4102-5
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发表时间：
2017-02-07
影响因子：
4.5
通讯作者：
Riley ED
中科院分区：
文献类型：
--
作者：
Page K;Yu M;Cohen J;Evans J;Shumway M;Riley ED
由于指南的更新以及新的治疗方法的出现，丙型肝炎病毒（HCV）筛查已具有新的重要意义。相对较少的研究对无家可归人群的丙型肝炎病毒感染情况进行了评估，且其中只有少数研究包括女性。我们对旧金山一组无家可归和居住不稳定的女性的丙型肝炎病毒感染率及其相关因素进行了评估，并估算了未确诊的比例。
在旧金山的免费供餐项目点、无家可归者收容所和低成本的单人房间旅店招募了246名女性作为概率样本；对感染人类免疫缺陷病毒（HIV）的女性进行了过度抽样。在基线水平，使用酶联免疫吸附测定法评估抗丙型肝炎病毒状态，并对感染HIV和未感染HIV的女性的结果进行比较。通过自我报告评估相关接触情况。采用逻辑回归分析评估与丙型肝炎病毒接触独立相关的因素。
在246名女性中，45.9%抗丙型肝炎病毒呈阳性，其中61.1%同时感染HIV；27.4%的阳性者报告此前未接受过筛查。大多数（72%）女性属于“婴儿潮一代”出生队列；19%报告近期有注射吸毒行为。与抗丙型肝炎病毒阳性独立相关的因素包括：出生于1965年或更早（调整优势比为3.94；95%置信区间：1.88 - 8.26）、有注射吸毒史（调整优势比为4.0；95%置信区间：1.68 - 9.55）以及精神疾病诊断数量（调整优势比为1.16；95%置信区间：1.08 - 1.25）。
研究结果填补了无家可归女性丙型肝炎病毒相关信息的重要空白，并证实了在这一人群中加强筛查的必要性，因为这一人群中很大比例是婴儿潮一代，且有吸毒史和精神问题。由于她们的年龄和风险状况，本研究中的女性很有可能已经感染了数十年，因此患有严重的肝脏疾病。精神疾病与丙型肝炎病毒之间的关联表明，除了加强筛查外，增加心理健康护理和支持可能会提高治疗成功率。
本文的网络版（doi:10.1186/s12889 - 2017 - 4102 - 5）包含补充材料，可供授权用户使用。
Hepatitis C virus (HCV) screening has taken on new importance as a result of updated guidelines and new curative therapies. Relatively few studies have assessed HCV infection in homeless populations, and a minority include women. We assessed prevalence and correlates of HCV exposure in a cohort of homeless and unstably housed women in San Francisco, and estimated the proportion undiagnosed. A probability sample of 246 women were recruited at free meal programs, homeless shelters, and low-cost single room occupancy hotels in San Francisco; women with HIV were oversampled. At baseline, anti-HCV status was assessed using an enzyme immunoassay, and results compared in both HIV-positive and negative women. Exposures were assessed by self-report. Logistic regression was used to assess factors independently associated th HCV exposure. Among 246 women 45.9% were anti-HCV positive, of whom 61.1% were HIV coinfected; 27.4% of positives reported no prior screening. Most (72%) women were in the ‘baby-boomer’ birth cohort; 19% reported recent injection drug use (IDU). Factors independently associated with anti-HCV positivity were: being born in 1965 or earlier (AOR) 3.94; 95%CI: 1.88, 8.26), IDU history (AOR 4.0; 95%CI: 1.68, 9.55), and number of psychiatric diagnoses (AOR 1.16; 95%CI: 1.08, 1.25). Results fill an important gap in information regarding HCV among homeless women, and confirm the need for enhanced screening in this population where a high proportion are baby-boomers and have a history of drug use and psychiatric problems. Due to their age and risk profile, there is a high probability that women in this study have been infected for decades, and thus have significant liver disease. The association with mental illness and HCV suggests that in addition increased screening, augmenting mental health care and support may enhance treatment success. The online version of this article (doi:10.1186/s12889-017-4102-5) contains supplementary material, which is available to authorized users.