Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews.
Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews.
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DOI：
10.1016/s0140-6736(11)61097-0
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发表时间：
2011-08-13
期刊：
影响因子：
168.9
通讯作者：
Degenhardt, Louisa
中科院分区：
文献类型：
--
作者：
Nelson, Paul K.;Mathers, Bradley M.;Cowie, Benjamin;Hagan, Holly;Des Jarlais, Don;Horyniak, Danielle;Degenhardt, Louisa
注射吸毒是病毒性肝炎传播的一个重要风险。从来没有对区域和全球一级的问题规模作出详细、透明的估计。我们报告了注射吸毒者中丙型肝炎（HCV）和B肝炎（HBV）的国家、区域和全球流行率和人口规模估计。同行评审（Medline/Embase/PsycINFO）和灰色文献数据库、会议摘要和在线资源的系统检索，以及广泛分布的额外数据。从4386篇同行评议文献和1019篇灰色文献来源中，对1125篇文献进行了全面综述。研究被提取到一个定制的数据库，并根据他们的方法进行分级。纳入了在n>40名参与者、<100% HIV阳性和不排除年龄或性别参与者的采样框架中的注射吸毒者样本中HCV抗体/抗HCV、HBV抗体/抗HBc和/或HBV表面抗原/HBsAg的血清学报告。使用认可的决策规则，以抗HCV和抗HBV作为暴露的替代物，以HBsAg作为当前感染，计算患病率估计值。这些数据与注射吸毒人群规模相结合，以估计HBV和HCV阳性注射吸毒者的数量。在77个国家找到了注射吸毒者中抗-HCV的合格报告。26个国家的流行率为60-80%，12个国家超过80%。我们估计全世界约有1000万（范围6.0- 15.2 M）注射吸毒者可能是抗-HCV阳性。中国（160万）、美国（150万）和俄罗斯联邦（130万）是迄今为止这类人口最多的国家。在59个国家发现了HBsAg报告，21个国家的报告率为5-10%，10个国家超过10%。在全球范围内，640万IDU可能是抗-HBc阳性（2.3-9.7M），120万（0.3-2.7M）HBsAg阳性。注射吸毒者中抗-HCV的流行率远远高于艾滋病毒。病毒性肝炎显然对公共卫生构成挑战。现有研究的覆盖面和质量的差异造成了估计数的不确定性。需要更好和更完整的数据和报告来估计问题的规模，为预防和治疗注射吸毒者中的HCV和HBV的努力提供信息。
Injecting drug use (IDU) is an important risk for viral hepatitis transmission. Detailed, transparent estimates of the scale of the problem at regional and global levels have never been made. We report national, regional and global prevalence and population size estimates for hepatitis C (HCV) and hepatitis B (HBV) among people who inject drugs. Systematic search of peer-reviewed (Medline/Embase/PsycINFO) and grey literature databases, conference abstracts and online resources, with a widely distributed call for additional data. From 4386 peer-reviewed and 1019 grey literature sources, 1125 were reviewed in full. Studies were extracted to a customised database and graded according their methods. Serological reports of HCV antibodies/anti-HCV, HBV antibodies/anti-HBc, and/or HBV surface antigen/HBsAg among IDUs samples with n>40 participants, <100% HIV-positive, and sampling frames that did not exclude participants on the basis of age or sex were included. Using endorsed decision rules, prevalence estimates were calculated with anti-HCV and anti-HBV as proxies for exposure and HBsAg for current infection. These were combined with IDU population sizes to estimate the number of HBV and HCV positive IDUs. Eligible reports of anti-HCV among IDUs were located for 77 countries. Prevalence was 60–80% in 26 countries and >80% in 12. We estimate worldwide about 10.0 million (range 6.0–15.2M) IDUs might be anti-HCV positive. China, (1.6M), the USA (1.5M) and the Russian Federation (1.3M) had by far the largest such populations. HBsAg reports were found for 59 countries, ranging from 5–10% in 21 countries and over 10% in 10. Worldwide, 6.4 million IDU might be anti-HBc positive (2.3–9.7M), and 1.2 million (0.3–2.7M) HBsAg positive. The prevalence of anti-HCV among IDUs is far greater than HIV. Viral hepatitis clearly poses a challenge to public health. Variation in the coverage and quality of existing research creates uncertainty around estimates. Better and more complete data and reporting are required to estimate the scale of the problem, to inform efforts to prevent and treat HCV and HBV among IDUs.