Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange-Importance for HCV elimination
Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange-Importance for HCV elimination
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DOI：
10.1111/jvh.12969
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发表时间：
2018-12-01
影响因子：
2.5
通讯作者：
Weiland, Ola
中科院分区：
文献类型：
--
作者：
Kaberg, Martin;Naver, Georg;Weiland, Ola
丙型肝炎病毒（HCV）的主要传播途径是通过注射毒品（PWID）的人之间共享未消毒的注射设备。世卫组织到2030年消除HCV的战略建议加大力度治疗推动HCV流行的PWID人群。在斯德哥尔摩针具交换方案的参与者中，HCV感染率为60%。我们的目的是研究NEP参与者中HCV的发病率、自发清除率以及与新发HCV感染和再感染相关的预测因素。2013年4月8日至2016年9月23日期间入组该计划的所有2320名患者均在基线时进行了HCV检测，并回答了有关社会人口学数据和注射风险行为的问卷调查。每隔3-6个月重复进行HCV检测。基线时NEP参与者的抗HCV患病率为77%，HCV RNA患病率为57%。24%的抗-HCV阳性者为HCV RNA阴性，HCV感染自发清除。总体HCV发病率为22/100 PY。HCV初治组的HCV发病率为26/100 PY，自发清除组为19/100 PY。两组HCV感染率无显著性差异（31% vs 29%），但HCV初治组的HCV自发清除率显著低于对照组（20% vs 44%，P < 0.05）。在PWID中注意到HCV的高发病率，这表明需要结合减少危害措施扩大治疗，以实现世卫组织设定的消除HCV的目标。这包括高覆盖率的针具交换方案和对药物使用者的有效戒毒治疗，包括阿片剂替代治疗。
The major transmission route for hepatitis C virus (HCV) is through sharing of unsterile injection equipment among people who inject drugs (PWID). The WHO strategy for HCV elimination by 2030 proposes increased efforts to treat PWID populations that drive the HCV epidemic. Among participants in the Stockholm needle exchange programme (NEP), the HCV prevalence is 60%. We aimed to study HCV incidence, spontaneous HCV clearance rate, and predictors associated with new HCV infections and reinfections in NEP participants. All 2320 patients enrolled in the programme between 8 April 2013 and 23 September 2016 were tested for HCV at baseline, and responded to a questionnaire regarding sociodemographic data and injection risk behaviour. Tests for HCV were repeated at an interval of 3-6 months. The anti-HCV prevalence in the NEP participants at baseline was 77%, and the prevalence of HCV RNA was 57%. 24% of the anti-HCV positive were HCV RNA negative with a spontaneously cleared HCV infection. The overall HCV incidence rate was 22/100 PY. The HCV incidence rate in the HCV naive group was 26/100 PY, and in the spontaneously cleared group 19/100. Although there were no significant differences in becoming HCV infected between the two groups (31% vs 29%), the rate of spontaneous HCV clearance was significantly lower in the HCV naive group, 20% vs 44%, (P < 0.05). A high HCV incidence rate was noted among the PWID indicating that treatment needs to be scaled up in conjunction with harm reduction measures to achieve HCV elimination goals set by WHO. This includes high coverage needle exchange programmes and effective addiction treatment for substance users, including opiate substitution treatment.