Opportunities for prevention:: Hepatitis C prevalence and incidence in a cohort of young injection drug users
Opportunities for prevention:: Hepatitis C prevalence and incidence in a cohort of young injection drug users
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DOI：
10.1053/jhep.2002.35065
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发表时间：
2002-09-01
期刊：
影响因子：
13.5
通讯作者：
Schechter, MT
中科院分区：
文献类型：
--
作者：
Miller, CL;Johnston, C;Schechter, MT
本研究的目的是比较丙型肝炎病毒(丙型肝炎病毒)基线阳性和阴性的年轻注射吸毒者(13-24岁)的社会人口学、药物和性危险特征，并确定年轻人中丙型肝炎病毒血清转换的预期危险因素。数据是通过温哥华注射毒品使用者研究(VIDUS)收集的。到目前为止，已有1400多名温哥华地区的静脉注射吸毒者登记并进行了跟踪；234名年龄在24岁及以下。参与者每半年完成一次面试者管理的问卷调查，并接受人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)的血清学测试。采用单变量和多变量Logistic回归分析来研究基线丙型肝炎病毒阳性的预测因素。在多变量分析中，使用具有时间依赖协变量的COX回归模型来识别丙型肝炎病毒血清转换率的预测因素。在232名年轻注射人员中，107人(46%)在基线时丙型肝炎病毒阳性，另有37人在研究期间血清转换，发病率为每100人年37.3人。基线阳性与土著血统、年龄较大、注射毒品年数较多、最近入狱、性交易工作、终身性伴侣超过100人、既往性传播疾病、居住在注射毒品中心以及每天注射海洛因、可卡因和速球超过一次有关。与丙型肝炎病毒血清转换独立相关的因素是有一个使用注射毒品的伴侣，需要帮助才能注射，以及每天注射一次以上的可卡因。总而言之，与年长的注射吸毒者不同，超过一半的年轻注射者在招募时丙型肝炎病毒阴性。因此，有一扇预防的机会之窗。然而，这些年轻的注射吸毒者中丙型肝炎病毒的发病率令人震惊，这表明干预的机会非常小。
The objective of this study was to compare sociodemographic, drug, and sexual risk characteristics between hepatitis C virus (HCV) baseline positive and negative young (13-24 years) injection drug users (IDUs) and to determine prospective risk factors for HCV seroconversion among the youth. Data were collected through the Vancouver Injection Drug Users Study (VIDUS). To date, more than 1,400 Vancouver-area IDUs have been enrolled and followed up; 234 were aged 24 years and younger. Semiannually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for human immunodeficiency virus (HIV) and HCV. Univariate and multivariate logistic regression analyses were undertaken to investigate predictors of baseline HCV positivity. In the multivariate analyses, Cox regression models with time-dependent covariates were used to identify predictors of HCV seroconversion. Of the 232 young injectors, 107 (46%) were HCV positive at baseline and a further 37 HCV seroconverted during the study period for an incidence rate of 37.3 per 100 person-years. Baseline positivity was associated with Aboriginal ancestry, older age, greater number of years injecting drugs, recent incarceration, sex trade work, more than 100 lifetime sexual partners, a previous sexually transmitted disease, living in the IDU epicenter, and injection more than once per day of heroin, cocaine, and speedball. Factors independently associated with HCV seroconversion were having a partner who uses injection drugs, requiring help to inject, and injection of cocaine more than once daily. In conclusion, unlike older IDUs, more than one half of young injectors were HCV negative at recruitment. Thus, there is a window of opportunity for prevention. However, the incidence rate of HCV among these young IDUs is alarming, suggesting that the opportunity to intervene is exceedingly small.