Geographic Differences in Temporal Incidence Trends of Hepatitis C Virus Infection Among People Who Inject Drugs: The InC3 Collaboration
Geographic Differences in Temporal Incidence Trends of Hepatitis C Virus Infection Among People Who Inject Drugs: The InC3 Collaboration
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DOI：
10.1093/cid/ciw869
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发表时间：
2017-04-01
影响因子：
11.8
通讯作者：
Page, Kimberly
中科院分区：
文献类型：
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作者：
Morris, Meghan D.;Shiboski, Stephen;Page, Kimberly
背景我们确定了美国（波士顿、巴尔的摩和旧金山弗朗西斯科）、加拿大（蒙特利尔）、荷兰（阿姆斯特丹）和澳大利亚（悉尼和墨尔本）注射毒品者（PWID）丙型肝炎病毒（HCV）发病率和相关行为暴露的时间趋势（1985-2011年）。使用HCV阴性PWID的基于人群的队列数据，我们计算了总体和城市内HCV发病率趋势、研究入组期（1985-2011年）的HCV发病率以及暴露行为的时间趋势。泊松回归模型估计了HCV发病率随时间的变化趋势.生存模型确定了城市间HCV感染的危险因素，并估计了城市和日历周期对HCV感染风险的独立影响。在前瞻性随访的1391例最初HCV阴性受试者中（1644.5人-年观察[PYO]），371例HCV事件感染导致总发病率为22.6/100 PYO（95%置信区间[CI]，20.4-25.0）。巴尔的摩（32.6/100 PYO）、旧金山弗朗西斯科（24.7/100 PYO）和蒙特利尔（23.5/100 PYO）的发生率最高并保持升高，墨尔本和阿姆斯特丹最低（分别为7.5/100 PYO和13.1/100 PYO），悉尼为中度（21.4/100 PYO）。在发病率最高的城市，较高的注射器和设备共用率和较低的阿片类激动剂治疗流行率与HCV发病率相关。每增加3年住院时间，感染风险下降18%（调整后的风险比，0.8 [95%CI，.8-. 9])在多变量模型中。预防策略和注射环境的差异可能解释了这些北美城市持续的高HCV发病率，并强调需要扩大阿片类激动剂治疗的规模，并增加北美针头和注射器计划的覆盖面。
Background. We determined temporal trends (1985-2011) in hepatitis C virus (HCV) incidence and associated behavioral exposures for people who inject drugs (PWID) from the United States (Boston, Baltimore, and San Francisco), Canada (Montreal), the Netherlands (Amsterdam), and Australia (Sydney and Melbourne).Methods. Using population-based cohort data from HCV-negative PWID, we calculated overall and within-city HCV incidence trends, HCV rates by study enrollment period (1985-2011), and temporal trends in exposure behaviors. Poisson regression models estimated trends in HCV incidence over calendar- time. Survival models identified risk factors for HCV incidence across cities and estimated independent effects of city and calendar period on HCV infection risk.Results. Among 1391 initially HCV-negative participants followed prospectively (1644.5 person-years of observation [PYO]), 371 HCV incident infections resulted in an overall incidence of 22.6 per 100 PYO (95% confidence interval [CI], 20.4-25.0). Incidence was highest and remained elevated in Baltimore (32.6/100 PYO), San Francisco (24.7/100 PYO), and Montreal (23.5/100 PYO), lowest in Melbourne and Amsterdam (7.5/100 PYO and 13.1/100 PYO, respectively), and moderate (21.4/100 PYO) in Sydney. Higher rates of syringe and equipment sharing and lower prevalence of opioid agonist therapy were associated with HCV incidence in cities with the highest incidence. Risk for infection dropped by 18% for every 3-year increase in calendar-time (adjusted hazard ratio, 0.8 [95% CI,.8-. 9]) in the multivariable model.Conclusions. Differences in prevention strategies and injecting contexts may explain the ongoing high HCV incidence in these North American cities and emphasize the need for scale-up of opioid agonist therapy and increased coverage of needle and syringe programs in North America.