Receptive syringe sharing and infection risk: to clean or not to clean.
Receptive syringe sharing and infection risk: to clean or not to clean.
复制标题
接受注射器共用和感染风险：清洁或不清洁。
DOI：
10.1086/653840
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Gyarmathy,VAnna
中科院分区：
文献类型：
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作者：
Gyarmathy,VAnna
致编辑-我怀着极大的兴趣阅读了Hagan等人[1]最近发表的文章，他们评估了美国5个城市483名注射吸毒者队列中丙型肝炎病毒（HCV）血清转换的预测因素。作者进行了一组8项多变量分析，详细阐述了HCV感染事件与注射设备共享的不同组合的相关性，他们发现药物制备设备的共享使用与HCV血清转换显著相关，而接受注射器共享则无关。在他们的讨论中，作者解释了接受性注射器共享与HCV血清转换缺乏关联，参与者仅与低风险伴侣共享注射器的故意降低风险策略。在匈牙利注射毒品使用者的横断面研究中，我们探讨了与HCV感染流行的关联[2]。为了检查注射器清洁在流行的HCV感染中所起的作用，我们为接受性注射器共享创建了2个变量：接受性注射器共享总是包括共享前的清洁，以及接受性注射器共享并不总是包括共享前的清洁。我们发现，虽然接受共用（1件式）注射器时，注射器总是清洁后再共用与流行的丙型肝炎病毒感染无关（多变量调整比值比[AOR]，0.7 [95%置信区间{CI}，0.2-1.9]），当注射器不总是清洁时，接受注射器共用显示出强烈的相关性（多变量AOR，3.1 [95% CI，1.1-8.9]）。我们的结论是，在我们的研究人群中，在接受性共用前彻底清洁使用过的单件式注射器可以将HCV感染的风险降低到使用无菌注射器的水平[2]。在阅读了Hagan等人的文章[1]后，我们对我们的数据进行了事后分析，并结合了2个接受性共用注射器变量（共享且总是清洁，以及共享但不总是清洁）分成1个变量（共享，不管清洁）。在这个事后多变量分析中-包含1个共用变量和来自原始多变量模型的所有其他变量-接受性注射器共用与HCV感染之间没有关联（多变量AOR，1.40 [95%CI，0.66-2.97]; P p）。虽然是一项横向研究。384劣于关于研究设计的前瞻性队列研究，我们的事后研究结果表明，Hagan等人[1]报告的接受性注射器共享与HCV血清转化之间缺乏相关性可能是注射器清洁混淆的结果。如果他们的调查问卷也评估了注射器清洁，那么看看在他们的多变量模型中包括2个变量（共享和总是清洁，以及共享但不总是清洁）而不是1个变量（共享，无论清洁与否）是否会改变他们的结果将是有趣的。
To the Editor—It was with great interest that I read the recent article by Hagan et al [1], who assessed predictors of hepatitis C virus (HCV) seroconversion among a cohort of 483 injection drug users in 5 US cities. The authors performed a set of 8 multivariate analyses elaborating on the association of incident HCV infection with different combinations of injecting equipment sharing, and they found that the shared use of drug preparation equipment was significantly associated with HCV seroconversion, whereas receptive syringe sharing was not. In their discussion, the authors explain the lack of association of receptive syringe sharing with HCV seroconversion with the deliberate risk reduction strategy of participants to share syringes only with low-risk partners. In a cross-sectional study among injecting drug users in Hungary, we explored associations with prevalent HCV infections [2]. To examine the role played by syringe cleaning in prevalent HCV infection, we created 2 variables for receptive syringe sharing: receptive syringe sharing that always included cleaning before sharing, and receptive syringe sharing that did not always include cleaning before sharing. We found that, although receptive sharing of (1-piece) syringes when the syringes were always cleaned before sharing was not associated with prevalent HCV infection (multivariate adjusted odds ratio [AOR], 0.7 [95% confidence interval {CI}, 0.2–1.9]), receptive syringe sharing when the syringe was not always cleaned showed a strong association (multivariate AOR, 3.1 [95% CI, 1.1–8.9]). We concluded that, in our study population, thorough cleaning of used 1-piece syringes before receptive sharing diminished the risk of HCV infection to the level of using sterile syringes [2].After having read the article by Hagan et al [1], we performed a post hoc analysis of our data and combined the 2 receptive syringe sharing variables (sharing and always cleaning, and sharing but not always cleaning) into 1 variable (sharing, regardless of cleaning). In this post hoc multivariate analysis—containing the 1 sharing variable and all other variables from the original multivariate model—there was no association between receptive syringe sharing and HCV infection (multivariate AOR, 1.40 [95% CI, 0.66–2.97]; P p). Although a cross-sectional study is. 384 inferior to a prospective cohort study concerning study design, our post hoc findings suggest that the lack of association between receptive syringe sharing and HCV seroconversion reported by Hagan et al [1] may be the result of confounding by syringe cleaning. If their questionnaire also assessed syringe cleaning, it would be interesting to see if including into their multivariate models 2 variables (sharing and always cleaning, and sharing but not always cleaning) instead of 1 variable (sharing, regardless of cleaning) would change their results.