Failure to diagnose recent hepatitis C virus infections in London injecting drug users
Failure to diagnose recent hepatitis C virus infections in London injecting drug users
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DOI：
10.1002/jmv.20124
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发表时间：
2004-08-01
影响因子：
12.7
通讯作者：
Tedder, R
中科院分区：
文献类型：
--
作者：
Aarons, E;Grant, P;Tedder, R
丙型肝炎病毒（HCV）感染导致很大一部分感染者出现慢性肝病。英国大多数新的丙型肝炎病毒感染病例与静脉注射毒品有关。识别这些感染非常重要，因为这对相关个人的未来健康和控制感染的进一步传播产生影响。然而，由于丙型肝炎感染的特点是血清阴性病毒血症的无症状期相对较长，因此不测试 HCV 血清阴性样本是否存在 HCV RNA 的实验室诊断方案可能会错误地将 HCV 病毒血清阴性个体指定为未感染者。在 14 个月的时间里，424 名注射吸毒者的血清被送到我们的诊断实验室进行“HCV 筛查”，HCV 血清阳性率为 48.4%。我们回顾性地确定了 7 名有近期感染 HCV 证据的个体。其中三种感染是使用我们的常规诊断方案确定的：检测 HCV 特异性抗体的存在，并仅对血清阳性和血清不确定的标本进行 HCV RNA 检测。然而，有 4 例病例仅通过 HCV 血清阴性血清的 HCV RNA 检测确诊。根据这些观察结果，我们估计伦敦注射吸毒者中 HCV 感染的发病率为每 100 人年 14.3 例。我们主张对从注射吸毒者获得的所有 HCV 血清阴性血液样本进行 HCV RNA 检测，并建议通过对小池样本进行核酸检测可以有效地做到这一点。 (C) 2004 Wiley-Liss, Inc.
Hepatitis C virus (HCV) infection results in chronicliver disease in a substantial proportion of those infected. Most new cases of HCV infection in the UK are associated with intravenous drug use. It is important to identify these infections because of the implications for the future health of the individuals concerned and for the control of further spread of infection. However, as hepatitis C infection is characterised by a relatively long asymptomatic period of seronegative viraemia, a laboratory diagnostic protocol that does not test HCV seronegative samples for the presence of HCV RNA may wrongly designate HCV viraemic seronegative individuals as uninfected. Amongst 424 injecting drug users whose serum was sent to our diagnostic laboratory for "HCV screening" over a 14-month period, the prevalence of HCV seropositivity was 48.4%. We retrospectively identified seven individuals for whom there was evidence of recent acquisition of HCV infection. Three of these infections were identified using our routine diagnostic protocol: testing for the presence of HCV-specific antibody and performing HCV RNA testing only on seropositive and seroindeterminate specimens. However, four cases were only identified by HCV RNA testing of HCV seronegative serum. On the basis of these observations, we estimate the incidence of HCV infection amongst London injecting drug users as being 14.3 per 100 person-years. We advocate that all HCV seronegative blood samples obtained from injecting drug users should be tested for the presence of HCV RNA, and suggest that this could be done efficiently by nucleic acid testing the specimens in small pools. (C) 2004 Wiley-Liss, Inc.