HIV/HCV co-infection and associated risk factors among injecting drug users in Dar es Salaam, Tanzania: potential for HCV elimination
HIV/HCV co-infection and associated risk factors among injecting drug users in Dar es Salaam, Tanzania: potential for HCV elimination
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DOI：
10.1186/s12954-019-0346-y
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发表时间：
2019-12-11
影响因子：
4.4
通讯作者：
Mmbaga, Elia John
中科院分区：
文献类型：
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作者：
Leyna, Germana Henry;Makyao, Neema;Mmbaga, Elia John
背景：慢性丙型肝炎病毒感染会导致相当大的发病率和死亡率，在与艾滋病毒合并感染时，可能会导致抗逆转录病毒治疗后的免疫学和病毒学失败。在非洲，对丙型肝炎病毒感染、与艾滋病毒混合感染和相关风险做法的估计在非洲很少。因此，这项研究旨在评估坦桑尼亚最大的大都市PWID中丙型肝炎病毒的流行率及其相关危险因素，为世卫组织提出消除建议提供依据。方法：采用受访者驱动抽样的综合生物行为调查方法，招募居住在坦桑尼亚达累斯萨拉姆的PWID。在面对面的访谈之后，采集血液样本进行艾滋病毒和丙型肝炎病毒检测。结果：共招募了611名PWID患者，年龄中位年龄34岁(IQR，29~38岁)，共招募4~8个波。大多数参与者(94.3%)是男性，首次注射的中位年龄为24岁(IQR，19-30)。据报道，只有6.55%(40/611)的参与者参加了阿片类药物治疗计划。加权丙型肝炎病毒抗体阳性率为16.2%(95%CI，13.0~20.1)。HIV感染率为8.7%(95%CI，6.4~11.8)。在51例HIV感染者中，有22例(43.1%)为丙型肝炎病毒血清阳性。缺少清洁针头(调整后的患病率为1.76；95%CI为1.44；12.74)、过去一个月共用针头(APR为1.72；95%CI为1.02；3.00)、最后一次共用针头未清洗(APR为2.29；95%CI为1.00；6.37)、无防护措施而不进行性行为(APR为1.87；95%CI为1.00；3.61)与丙型肝炎病毒感染的风险增加有关。另一方面，没有接受阿片类药物替代治疗与感染的可能性降低60%相关。结论：PWID中的丙型肝炎抗体流行率低于全球估计的消除潜力。改善获得安全注射用具的机会，促进更安全的注射做法是预防方案的重点。在HIV护理、阿片类药物替代计划和PWID的其他护理要点中，应加强对艾滋病毒/丙型肝炎合并感染的筛查。使用直接作用的抗逆转录病毒治疗将加速实现到2030年消除肝炎感染的目标。
Background: Chronic HCV infection causes substantial morbidity and mortality and, in co-infection with HIV, may result in immunological and virological failure following antiretroviral treatment. Estimates of HCV infection, co-infection with HIV and associated risk practices among PWID are scarce in Africa. This study therefore aimed at estimating the prevalence of HCV and associated risk factors among PWID in the largest metropolitan city in Tanzania to inform WHO elimination recommendations.Methods: An integrated bio-behavioral survey using respondent-driven sampling was used to recruit PWID residing in Dar es Salaam, Tanzania. Following face-to-face interviews, blood samples were collected for HIV and HCV testing. Weighted modified Poisson regression modeling with robust standard errors was used in the analysis.Results: A total of 611 PWID with a median age of 34 years (IQR, 29-38) were recruited through 4 to 8 waves. The majority of participants (94.3%) were males, and the median age at first injection was 24 years (IQR, 19-30). Only 6.55% (40/611) of participants reported to have been enrolled in opioid treatment programs. The weighted HCV antibody prevalence was 16.2% (95%CI, 13.0-20.1). The corresponding prevalence of HIV infection was 8.7% (95%CI, 6.4-11.8). Of the 51 PWID who were infected with HIV, 22 (43.1%) were HCV seropositive. Lack of access to clean needles (adjusted prevalence ratio (APR), 1.76; 95%CI, 1.44; 12.74), sharing a needle the past month (APR, 1.72; 95%CI, 1.02; 3.00), not cleaning the needle the last time shared (APR, 2.29; 95%CI, 1.00; 6.37), and having unprotected not using a transactional sex (APR, 1.87; 95%CI, 1.00; 3.61) were associated with increased risk of HCV infection. On the other hand, not being on opioid substitution therapy was associated with 60% lower likelihood of infection.Conclusions: The HCV antibody prevalence among PWID is lower than global estimates indicating potential for elimination. Improving access to safe injecting paraphernalia, promoting safer injecting practices is the focus of prevention programing. Screening for HIV/HCV co-infection should be intensified in HIV care, opioid substitution programs, and other point of care for PWID. Use of direct-acting antiretroviral treatment would accelerate the achievement of hepatitis infection elimination goal by 2030.