Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment.
Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment.
复制标题
DOI：
10.1111/j.1360-0443.2011.03765.x
复制
发表时间：
2012-06
期刊：
影响因子：
--
通讯作者：
Des Jarlais DC
中科院分区：
文献类型：
--
作者：
Pouget ER;Hagan H;Des Jarlais DC
我们对注射吸毒者(IDU)中与共用注射器和药物制备设备有关的丙型肝炎感染(丙型肝炎)血清发病率的研究进行了系统的回顾。我们确定了21项符合纳入标准的已发表和未发表的研究。我们用随机效应荟萃分析估计了共用注射器和药物制备设备对丙型肝炎病毒传播的相对贡献，并分析了不同研究之间效应异质性的潜在来源。共用注射器与丙型肝炎病毒血清转换率相关(合并风险比PRR=1.97，95%可信区间(95%CI)=1.57，2.49)，共用药物制剂容器(PRR=2.42，95%CI=1.89，3.10)，过滤器(PRR=2.61，95%CI=1.91，3.56)，冲洗水(PRR=1.98，95%CI=1.54，2.56)，这些设备的组合(PRR=2.24，95%CI=1.28，3.93)，“回装”，一种注射器介导的共享预制药物的形式(PRR=1.86，95%CI=1.41，2.44)。Meta回归结果显示，注射吸毒者人群中的丙型肝炎病毒血清阳性率改变了共用注射器和血清转换之间的关联。通过共用注射器感染丙型肝炎的风险取决于人群中丙型肝炎感染的血清阳性率。通过共用药物制备设备感染丙型肝炎的风险与共用注射器的风险相似。由于共用伴侣的感染状况通常不清楚，注射吸毒者必须始终如一地避免共用准备、分配或注射毒品时使用的无菌设备，并避免使用未经消毒的注射器积压。
We conducted a systematic review of studies reporting seroincidence of Hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified 21 published and unpublished studies that met inclusion criteria. We estimated the relative contributions of shared syringes and drug preparation equipment to HCV transmission using random-effects meta-analysis, and analyzed potential sources of heterogeneity of effects among studies. Syringe sharing was associated with HCV seroconversion (Pooled Risk Ratio (PRR) = 1.97, 95% confidence interval (95% CI) = 1.57, 2.49), as was sharing drug preparation containers (PRR = 2.42, 95% CI = 1.89, 3.10), filters (PRR = 2.61, 95% CI = 1.91, 3.56), rinse water (PRR = 1.98, 95% CI = 1.54, 2.56), combinations of this equipment (PRR = 2.24, 95% CI = 1.28, 3.93), and “backloading,” a syringe-mediated form of sharing prepared drugs (PRR = 1.86, 95% CI = 1.41, 2.44). Meta-regression results showed that the association between syringe sharing and seroconversion was modified by HCV seroprevalence in the IDU populations. The risk of Hepatitis C infection through shared syringes is dependent upon Hepatitis C infection seroprevalence in the population. The risk of Hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Since the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide, or inject drugs, and avoid backloading with an unsterile syringe.