Determinants of persistent spread of HIV in HCV-infected populations of injecting drug users
Determinants of persistent spread of HIV in HCV-infected populations of injecting drug users
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DOI：
10.1016/j.epidem.2012.01.001
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发表时间：
2012-06-01
期刊：
影响因子：
3.8
通讯作者：
Kretzschmar, Mirjam E.
中科院分区：
文献类型：
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作者：
de Vos, Anneke S.;van der Helm, Jannie J.;Kretzschmar, Mirjam E.
丙型肝炎病毒(HCV)和人类免疫缺陷病毒(HIV)都是通过共用受污染的注射器而通过注射吸毒者(IDU)人群传播的。丙型肝炎病毒在大多数注射吸毒者人群中的流行率很高，而艾滋病毒的流行率在不同人群中差别很大。了解这些相互作用的感染的动态可能使我们能够使用丙型肝炎病毒流行率作为艾滋病毒持续传播风险的指标。我们开发了一个数学模型，描述了丙型肝炎病毒和艾滋病毒在借条人群中的传播。该模型允许丙型肝炎病毒和艾滋病毒混合感染，并增加了这两种感染的疾病相关死亡率。利用这个模型，我们研究了HIV和丙型肝炎病毒的流行如何依赖于注射危险行为的水平和异质性，以及HIV和丙型肝炎病毒的流行如何相关。为了了解实际的危险行为，我们分析了阿姆斯特丹队列研究(ACS)对吸毒者的数据。我们发现，HIV可以侵入IDU人群的丙型肝炎病毒流行率存在一个阈值；低于阈值的HIV不能传播。这一门槛在很大程度上取决于人群中风险行为的异质性，以及风险行为群体之间是否更有可能共享风险行为。我们发现，我们的模型符合Vickerman等人所描述的丙型肝炎病毒和艾滋病毒流行率之间的观察到的关系。(2010)，除了符合美国癌症协会的风险异质性外，我们还假设大多数接触者(>；90%)发生在相同风险水平(混合)的IOU中。我们得出结论，丙型肝炎病毒流行率可以作为成功将艾滋病毒感染到静脉注射吸毒者人群的风险指标。然而，关于风险异质性的信息对于确定这种风险以及设计有效的预防策略是必要的。(C)2012爱思唯尔B.V.保留所有权利。
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are both transmitted through populations of injecting drug users (IDU) by the sharing of contaminated syringes. Prevalence of HCV is high in most IDU populations, whereas HIV prevalence varies considerably across populations. Understanding the dynamics of these interacting infections may allow us to use HCV prevalence as an indicator for the risk of persistent spread of HIV.We developed a mathematical model that describes the spread of both HCV and HIV in an IOU population. The model allows for HCV-HIV co-infection and increased disease related mortality for both infections. Using this model we investigated how HIV and HCV prevalence both depend on level and heterogeneity of injecting risk behaviour, and how HIV and HCV prevalence are related. To gain knowledge of actual risk behaviour we analysed data from the Amsterdam Cohort Study (ACS) of drug users.We find that there is a threshold HCV prevalence at which HIV can invade into an IDU population; below threshold HIV cannot spread. This threshold depends strongly on heterogeneity of risk behaviour in the population, as well as on whether sharing is more likely to occur within or between risk behaviour groups. We find that our model agrees with the observed relationship between HCV and HIV prevalence as described by Vickerman et al. (2010), when in addition to risk heterogeneity as fitted from the ACS, we also assume that most contacts (>90%) occur amongst IOU of the same risk level (assortative mixing).We conclude that HCV prevalence can be used as an indicator of risk for successful HIV introduction into an IDU population. However, information on risk heterogeneity is required for determining this risk, and also for designing effective prevention strategies. (C) 2012 Elsevier B.V. All rights reserved.