The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users
The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users
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DOI：
10.1111/j.1360-0443.2012.03803.x
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发表时间：
2012-07-01
期刊：
影响因子：
6
通讯作者：
Jutras-Aswad, Didier
中科院分区：
文献类型：
--
作者：
Bruneau, Julie;Roy, Elise;Jutras-Aswad, Didier
目的 研究处方阿片类药物 (PO) 注射的趋势，并评估其与注射吸毒者 (IDU) 中丙型肝炎病毒 (HCV) 血清转化的关系。设计前瞻性队列研究。背景设定为加拿大蒙特利尔。参与者在基线时为 HCV 阴性注射吸毒者，报告在过去一个月注射过注射剂。测量 每半年访视一次，包括 HCV 抗体检测和评估风险行为的访谈问卷。 HCV发病率采用人次法计算。采用时间更新的 Cox 回归模型来检查 HCV 发病率的预测因素。结果 2004 年至 2009 年间，报告注射 PO 的注射吸毒者比例从 21% 增加到 75%（P < 0.001）。在 246 名参与者中（81.6% 为男性；平均年龄 34.5 岁；平均随访时间 23 个月），83 人血清转化为 HCV [发病率：每 100 人年 17.9 人； 95% 置信区间 (CI) 14.3, 22.1]。与非 PO 注射者相比，PO 注射者更容易被感染[调整后的危险比（AHR）：1.87； 95%置信区间:1.16, 3.03]。还发现了一种效应修正：未注射海洛因的 PO 注射者更容易被感染（AHR：2.88；95% CI：1.52，5.45），而使用两种药物的参与者则没有发现关联（AHR：1.19；95% CI：0.61，2.30）。 HCV 发病率的其他独立预测因素包括：可卡因注射、近期监禁以及每月注射次数 > 30 次。结论 不注射海洛因的处方阿片类药物注射者比同时注射海洛因和处方阿片类药物的注射者发生丙型肝炎病毒血清转化的风险更大。年龄、行为和社会背景的重要差异表明需要针对这一人群制定有针对性的外展策略。
Aims To examine trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among injection drug users (IDUs). Design Prospective cohort study. Setting Montreal, Canada. Participants HCV-negative IDUs at baseline, reporting injection in the past month. Measurements Semi-annual visits included HCV antibody testing and an interview-administered questionnaire assessing risk behaviours. HCV incidence rate was calculated using the persontime method. Time-updated Cox regression models were conducted to examine predictors of HCV incidence. Findings The proportion of IDUs reporting PO injection increased from 21% to 75% between 2004 and 2009 (P < 0.001). Of the 246 participants (81.6% male; mean age 34.5 years; mean follow-up time 23 months), 83 seroconverted to HCV [incidence rate: 17.9 per 100 person-years; 95% confidence interval (CI) 14.3, 22.1]. Compared to non-PO injectors, PO injectors were more likely to become infected [adjusted hazard ratio (AHR): 1.87; 95%CI:1.16, 3.03]. An effect modification was also found: PO injectors who did not inject heroin were more likely to become infected (AHR: 2.88; 95%CI: 1.52, 5.45) whereas no association was found for participants using both drugs (AHR: 1.19; 95% CI: 0.61, 2.30). Other independent predictors of HCV incidence were: cocaine injection, recent incarceration and >30 injections per month. Conclusions Prescription opioid injectors who do not inject heroin are at greater risk for HCV seroconversion than are those injecting both heroin and prescription opioids. Important differences in age, behaviour and social context suggest a need for targeted outreach strategies to this population.