Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013
Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013
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DOI：
10.1016/s1473-3099(16)30325-5
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发表时间：
2016-12-01
影响因子：
56.3
通讯作者：
Vos, Theo
中科院分区：
文献类型：
--
作者：
Degenhardt, Louisa;Charlson, Fiona;Vos, Theo
背景以前对注射吸毒者中艾滋病毒、B肝炎病毒（HBV）和丙型肝炎病毒（HCV）负担的估计未包括对过去注射后果造成的负担的估计。我们的目的是提供这些估计作为全球疾病负担（GBD）研究2013的一部分。方法我们在国家，地区和全球层面模拟HBV和HCV（包括肝硬化和肝癌负担）和HIV的负担。我们提取了联合国关于按传播途径分列的已报告艾滋病毒病例比例的数据，并使用队列方法估计了注射吸毒（IDU）对HBV和HCV疾病负担的贡献，该方法重新校准了个体的IDU历史，以及因IDU而累积的HBV和HCV风险。我们通过对注射吸毒者中HBV和HCV发病率的荟萃分析以及1990年至2013年期间HBV和HCV发病率的国家级数据，估计了目前注射吸毒者的数据。我们通过寿命损失年数（YLL）、残疾生存年数（YLD）、死亡和残疾调整生命年数（DADs）计算了疾病负担的估计值，并计算了每个指标的95%不确定区间（UI）。结果2013年，估计有1008万DADs可归因于既往通过静脉吸毒暴露于HIV、HBV和HCV，自1990年以来增长了四倍。在2013年，IDU估计导致4.0%（282万例DADs，95% UI 240万至380万例）的HIV DADs，1.1%（216000，101000 -338000例）的HBV DADs和39.1%（705万，588万至815万例）的HCV DADs。IDU引起的HIV负担在中低收入国家最高，而IDU引起的HCV负担在高收入国家最高。需要扩大有效干预措施，以预防和治疗这些造成健康负担的重要原因。版权所有（C）作者。爱思唯尔有限公司出版
Background Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013.Methods We modelled the burden of HBV and HCV (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted United Nations data on the proportion of notified HIV cases by transmission route, and estimated the contribution of injecting drug use (IDU) to HBV and HCV disease burden by use of a cohort method that recalibrated individuals' history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injecting drug users and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability adjusted life-years (DALYs), with 95% uncertainty intervals (UIs) calculated for each metric.Findings In 2013, an estimated 10.08 million DALYs were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990. In total in 2013, IDU was estimated to cause 4.0% (2.82 million DALYs, 95% UI 2.4 million to 3.8 million) of DALYs due to HIV, 1.1% (216000,101000-338000) of DALYs due to HBV, and 39.1% (7.05 million, 5.88 million to 8.15 million) of DALYs due to HCV. IDU-attributable HIV burden was highest in low-to-middle-income countries, and IDU-attributable HCV burden was highest in high-income countries.Interpretation IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up. Copyright (C) The Author(s). Published by Elsevier Ltd.