Sexual behaviour as a risk factor for hepatitis C virus infection among people who inject drugs in Montreal, Canada
Sexual behaviour as a risk factor for hepatitis C virus infection among people who inject drugs in Montreal, Canada
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DOI：
10.1111/jvh.13194
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发表时间：
2019-12-01
影响因子：
2.5
通讯作者：
Bruneau, Julie
中科院分区：
文献类型：
--
作者：
Jacka, Brendan;Roy, Elise;Bruneau, Julie
丙型肝炎病毒（HCV）感染在主要危险环境中仍然很高，包括注射吸毒和男性之间的性行为。然而，很少有研究考察性行为对注射吸毒者（PWID）中丙型肝炎病毒感染的独立贡献。在一项蒙特利尔PWID前瞻性队列研究中（2004-2017），我们估计了HCV发病率，并检查了性行为作为HCV获得的时变预测因子。最初，丙型肝炎病毒阴性参与者完成行为问卷和丙型肝炎病毒抗体检测（至2011年6个月，此后3个月）。一个时间更新的暴露变量（无性别，只有异性伴侣，>= 1同性伴侣）被生成为前6/3个月。使用Cox回归分析检查HCV血清转化时间，调整年龄，不稳定住房和监禁（过去3个月），以及每日，海洛因，可卡因和处方阿片类药物注射（过去一个月）。在440名PWID患者中（基线：中位年龄33岁，18.9%女性，1.4% hiv阳性），156名参与者在随访期间血清转化（总发病率：11.9/100人年[PY]）。无性别组发病率最低（男女分别为8.70例和2.91例/100 PY）， >= 1同性伴侣组发病率最高（男女分别为24.14例和21.97例/100 PY）。在男性中，与>= 1同性伴侣相比，无性行为者的HCV风险降低47%（校正风险比：0.53,95%可信区间：0.28,0.99）。在这一PWID队列中，报告最近有同性伴侣的男性感染丙型肝炎病毒的风险更高，因此有必要采取有针对性的减少伤害策略，考虑性行为和注射风险行为之间复杂的相互作用。
Hepatitis C virus (HCV) acquisition remains high in key risk environments including injection drug use and sex between men. However, few studies examine the independent contribution of sexual behaviour to HCV acquisition among people who inject drugs (PWID). We estimated HCV incidence and examined sexual behaviour as a time-varying predictor of HCV acquisition in a prospective cohort study of PWID in Montreal (2004-2017). Initially, HCV-negative participants completed behavioural questionnaires and HCV antibody testing (6 months until 2011, 3 months thereafter). A time-updating exposure variable (no sex, opposite-sex partner only, >= 1 same-sex partner) was generated for the previous 6/3 months. Time to HCV seroconversion was examined using Cox regression analysis, adjusted for age, unstable housing and incarceration (both past 3 months), and daily, heroin, cocaine and prescription opioid injecting (all past month). Among 440 PWID (baseline: median age 33 years, 18.9% female, 1.4% HIV-positive), 156 participants seroconverted during follow-up (overall incidence rate: 11.9/100 person-years [PY]). Incidence was lowest in the no sex group (8.70 and 2.91 cases/100 PY in males and females, respectively) and highest in the >= 1 same-sex partner group (24.14 and 21.97 cases/100 PY in males and females, respectively). Among males, HCV risk was 47% lower in those reporting no sex compared to >= 1 same-sex partner (adjusted hazard ratio: 0.53, 95% confidence interval: 0.28, 0.99). In this cohort of PWID, reporting recent same-sex partners was associated with greater risk of HCV acquisition among males, necessitating targeted harm reduction strategies that consider the complex interplay of sexual and injecting risk behaviours.