HEPATITIS C INFECTION & DIABETES IN INJECTION DRUG USERS

建议进行一项两阶段研究，以检查丙型肝炎病毒（HCV）感染与随后发生的2型糖尿病之间的关系。 最近第三次全国健康和营养检查调查和其他研究的证据表明了这种联系。 鉴于注射吸毒者（IDUs）中HCV感染的高流行率（约90%），这项研究对IDUs的健康有巨大的影响。 I期包括一项病例队列研究，以确定在社区男性和女性的大型队列中HCV感染和2型糖尿病之间是否存在独立的因果关系。 我们将从社区动脉粥样硬化风险（ARIC）研究中招募436例新发糖尿病病例和872例年龄匹配的对照，并将评估糖尿病发作前采集的冷冻血清样本中HCV抗体的存在。 在第二阶段，我们将在马里兰州的巴尔的摩对来自一个大型静脉注射吸毒者队列（艾滋病与静脉注射经历的联系）的抗-HCV阳性个体的一个子集（n=210）进行糖尿病检测。 2型糖尿病病例将与年龄匹配的对照组比较HCV病毒特征（如HCV RNA、肝酶和HCV基因型）的差异，以试图阐明这种拟议关联的机制。 这项研究的结果将推动未来的流行病学和生理学研究，以了解肝病在糖尿病发病机制中的作用，以及在承担大部分丙型肝炎病毒流行负担的人群中（如IDUS）的潜在糖尿病预防计划。

Proposed is a two-phase study to examine the association between hepatitis C virus (HCV) infection and subsequent development of type 2 diabetes mellitus. Recent evidence from the third National Health and Nutrition Examination Survey and other studies suggest such an association. Given the high prevalence of HCV infection (approximately 90 percent) in injection drug users (IDUs), this study has tremendous health implications for IDUs. Phase I involves a case-cohort study to determine whether there is an independent causal association between HCV infection and type 2 diabetes in a large cohort of community-based men and women. We will enroll 436 incident diabetes cases and 872 age- matched controls from the Atherosclerosis Risk in Communities (ARIC) study and will assess the presence of HCV antibody from frozen serum samples taken prior to the onset of diabetes. In Phase II, we will test a subset (n=210) of anti-HCV positive individuals from a large cohort of IDUs (AIDS Link to Intravenous Experiences) in Baltimore, Maryland for diabetes. Cases of type 2 diabetes will be compared to age-matched controls for differences in HCV viral characteristics such as HCV RNA, liver enzymes and HCV genotype in an attempt to elucidate the mechanism of this proposed association. The results of this study will drive future epidemiological and physiological research into the role of liver disease in the pathogenesis of diabetes as well as potential diabetes prevention programs in populations such as IDUS who bear most of the burden of the hepatitis C virus epidemic.