Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention.
Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention.
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DOI：
10.1371/journal.pone.0103345
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Matheï C
中科院分区：
文献类型：
--
作者：
Wiessing L;Ferri M;Grady B;Kantzanou M;Sperle I;Cullen KJ;EMCDDA DRID group;Hatzakis A;Prins M;Vickerman P;Lazarus JV;Hope VD;Matheï C
注射吸毒者（PWID）是受丙型肝炎病毒（HCV）影响的关键人群。治疗选择正在改善，可能会加强预防;但PWID的获取可能很差。本文系统回顾了在欧盟27个国家中，7个主要主题领域（发病率、慢性化、基因型、HIV合并感染、诊断和治疗吸收以及疾病负担）的文献信息，以指导PWID的HCV治疗和预防规模的扩大。我们检索了MEDLINE、EMBASE和科克伦图书馆2000年1月1日至2012年12月31日期间的出版物，检索策略为关于病毒性肝炎、药物滥用和地理范围的一般关键词以及主题特定关键词。通过与一个大型欧洲专家网络的结构化电子邮件协商，发现了更多的文章。数据的可得性差异很大，在可比性和代表性方面存在重大限制。27个国家中有9个国家有PWID中HCV发病率的数据，通常很高（2.7-66/100人-年，中位数13，四分位数间距（IQR）8.7-28）。最常见的HCV基因型是G1和G3;然而，G4可能正在增加，而传统的“难以治疗”基因型（G1+G4）的比例显示出很大的变化（中位数53，IQR 43-62）。12个国家报告了HCV慢性化（中位数72，IQR 64-81），22个国家报告了HCV感染PWID中的HIV流行率（中位数3.9%，IQR 0.2-28）。在五个国家评估的未确诊感染率较高（中位数49%，IQR 38-64），而在确诊感染者中，进入治疗的比例较低（中位数9.5%，IQR 3.5-15）。经评估，疾病负担很高，并将在今后十年上升。欧洲PWID中HCV流行病学，护理和疾病负担的关键数据很少，但表明许多未确诊的感染和治疗效果差。需要更大的努力来提高数据的可用性，以指导PWID中HCV治疗的增加。
People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7–28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally ‘difficult to treat’ genotypes (G1+G4) showed large variation (median 53, IQR 43–62). Twelve countries reported on HCV chronicity (median 72, IQR 64–81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2–28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38–64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5–15). Burden of disease, where assessed, was high and will rise in the next decade. Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.
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