Drug use and phylogenetic clustering of hepatitis C virus infection among people who use drugs in Vancouver, Canada: A latent class analysis approach
Drug use and phylogenetic clustering of hepatitis C virus infection among people who use drugs in Vancouver, Canada: A latent class analysis approach
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DOI：
10.1111/jvh.12758
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发表时间：
2018-01-01
影响因子：
2.5
通讯作者：
Grebely, J., Sr.
中科院分区：
文献类型：
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作者：
Jacka, B.;Bray, B. C.;Grebely, J., Sr.
本研究估计了加拿大温哥华吸毒人群的潜在类别（即人群中未观察到的亚群），并研究了这些类别与丙型肝炎病毒（HCV）感染的系统发育聚类的关系。纳入了使用来自加拿大温哥华（1996-2012年）两个队列药物的HCV抗体阳性患者，其具有Core-E2序列。时间戳系统发育树推断，和系统发育聚类的时间来确定最常见的最近的祖先。潜在的类估计，并与系统发育聚类结果的关联进行了评估，使用一个包容性的分类/分析方法。在699名HCV RNA阳性参与者（26%为女性，24%为HIV+）中，近期吸毒包括注射可卡因（80%）、注射海洛因（70%）、注射可卡因/海洛因（即，快球，38%）和吸食快克可卡因（28%）。潜在类别分析确定了四个不同的药物使用类型亚组：（i）可卡因注射，（ii）阿片类药物和可卡因注射，（iii）吸食快克可卡因和（iv）海洛因注射并目前接受阿片类药物替代治疗。在调整了年龄和艾滋病毒感染后，与海洛因注射和目前接受阿片类药物替代治疗的组相比，可卡因注射组的系统发生簇成员资格的几率更大（调整OR [aOR]：3.06; 95%CI：1.73，5.42），可卡因组较低（aOR：0.06; 95%CI：0.01，0.48）。结合潜在的类和系统发育聚类分析提供了新的见解复杂的动态丙型肝炎病毒传播。阐明与药物使用相关的不同风险特征可能为进一步优化和靶向HCV治疗和预防策略提供机会。
This study estimated latent classes (ie, unobserved subgroups in a population) of people who use drugs in Vancouver, Canada, and examined how these classes relate to phylogenetic clustering of hepatitis C virus (HCV) infection. HCV antibody-positive people who use drugs from two cohorts in Vancouver, Canada (1996-2012), with a Core-E2 sequence were included. Time-stamped phylogenetic trees were inferred, and phylogenetic clustering was determined by time to most common recent ancestor. Latent classes were estimated, and the association with the phylogenetic clustering outcome was assessed using an inclusive classify/analyse approach. Among 699 HCV RNA-positive participants (26% female, 24% HIV+), recent drug use included injecting cocaine (80%), injecting heroin (70%), injecting cocaine/heroin (ie, speedball, 38%) and crack cocaine smoking (28%). Latent class analysis identified four distinct subgroups of drug use typologies: (i) cocaine injecting, (ii) opioid and cocaine injecting, (iii) crack cocaine smoking and (iv) heroin injecting and currently receiving opioid substitution therapy. After adjusting for age and HIV infection, compared to the group defined by heroin injecting and currently receiving opioid substitution therapy, the odds of phylogenetic cluster membership was greater in the cocaine injecting group (adjusted OR [aOR]: 3.06; 95% CI: 1.73, 5.42) and lower in the crack cocaine smoking group (aOR: 0.06; 95% CI: 0.01, 0.48). Combining latent class and phylogenetic clustering analyses provides novel insights into the complex dynamics of HCV transmission. Incorporating differing risk profiles associated with drug use may provide opportunities to further optimize and target HCV treatment and prevention strategies.