Prevalence and Incidence of HCV Infection among Vietnam Heroin Users with Recent Onset of Injection
Prevalence and Incidence of HCV Infection among Vietnam Heroin Users with Recent Onset of Injection
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DOI：
10.1007/s11524-009-9417-9
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发表时间：
2010-03-01
影响因子：
6.6
通讯作者：
Goldsamt, Lloyd A.
中科院分区：
文献类型：
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作者：
Clatts, Michael C.;Colon-Lopez, Vivian;Goldsamt, Lloyd A.
HCV感染继续以惊人的速度在注射吸毒人群中蔓延。现有证据表明，HCV在注射开始后相对较快地获得。然而，很少有丙型肝炎病毒感染的前瞻性研究，特别是在资源匮乏的环境中的注射吸毒人群。在越南河内招募了一名最近开始注射（< 4岁）的年轻男性海洛因注射者样本，对早期注射过程进行前瞻性评估（n = 179）。在基线时进行行为和生物学评估（包括注射开始的详细回顾性评估），并在16个月内每6个月重复一次。考虑将双变量分析中与HCV感染相关的变量（p值< 0.05）纳入逻辑回归模型，以确定与HCV感染独立相关的风险因素。使用发病密度法计算HCV发病率，并以观察人年表示。基线HCV感染率为46%。自首次注射以来，HCV显著增加，从千分之一货币符号10个月注射风险的受试者的30%增加到千分之一日元30个月注射风险的受试者的70%（p值= 0.0005）。在多因素logistic回归分析中，年龄增加、在毒品拘留所的监禁（OR = 2.54; 95%CI 1.05，6.15）和首次注射后的时间与HCV感染显著相关。使用注射作为主要给药方式（OR = 2.56; 95%CI 0.98，6.69）达到边缘显著性。随访16个月后，HCV的发病率为23.35/100人年，首次注射与首次HCV检测阳性之间的平均时间为1.2年。HCV在新注射人群中的获得速度比以前认识到的要快得多，这表明需要在新的海洛因使用者人群中进行早期行为干预。特别重要的是针对新的海洛因使用者群体的干预措施，包括提高对病毒传播动态的认识、促进药物分享替代战略和推迟开始注射的干预措施。
HCV infection continues to spread at an alarming rate among IDU populations. The available evidence suggests that HCV is acquired relatively quickly following onset of injection. However, there are few prospective studies of HCV acquisition, particularly among IDU populations in resource-poor settings. A sample of young male heroin injectors with recent onset of injection (< 4 years) was recruited in Hanoi, Vietnam for a prospective assessment of the early course of injection (n = 179). Both behavioral and biological assessments (including detailed retrospective assessment of injection initiation) were conducted at baseline and repeated at 6-month intervals for a period of 16 months. Variables associated with HCV infection (p value < 0.05) in bivariate analyses were considered for inclusion in logistic regression models to identify risk factors independently associated with HCV infection. HCV incidence was calculated by using the incidence density approach and was expressed in terms of person-years of observation. The baseline of prevalence of HCV was 46%. HCV significantly increased in relation to time since first injection, from 30% in subjects with a parts per thousand currency sign10 months of injection risk to 70% in subjects with a parts per thousand yen30 months injection risk (p value = 0.0005). In multivariate logistic regression analysis, increasing age, incarceration in a drug detention facility (OR = 2.54; 95%CI 1.05, 6.15), and time since first injection remained significantly associated with HCV infection. Use of injection as primary mode of administration (OR = 2.56; 95%CI 0.98, 6.69) achieved marginal significance. After 16 months of follow-up, the incidence rate of HCV was 23.35 per 100 person-years and the mean time between first injection and first positive HCV test was 1.2 years. HCV is acquired much more rapidly among new injector populations than previously recognized, demonstrating the need for early behavioral intervention among new heroin-user populations. Particularly critical are interventions that target new heroin user populations, including interventions that improve understanding of viral transmission dynamics, that promote alternative strategies for drug sharing, and that delay initiation of injection.