HEPATITIS C INFECTION & DIABETES IN INJECTION DRUG USERS

提出了一项两期研究，以检查丙型肝炎病毒（HCV）感染与随后发展为2型糖尿病之间的关系。最近来自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HCV感染在注射吸毒者（IDUs）中的高流行率（约90%），该研究对注射吸毒者具有巨大的健康意义。第一阶段涉及一项病例队列研究，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例糖尿病病例和872例年龄匹配的对照组，并将评估糖尿病发病前采集的冷冻血清样本中HCV抗体的存在。在II期研究中，我们将从马里兰州巴尔的摩市的大量IDUs（艾滋病与静脉注射相关）患者中检测一个亚群（n=210）抗hcv阳性个体是否患有糖尿病。将2型糖尿病患者与年龄匹配的对照组进行比较，以了解HCV病毒特征（如HCV RNA、肝酶和HCV基因型）的差异，试图阐明这种关联的机制。这项研究的结果将推动未来流行病学和生理学研究肝病在糖尿病发病机制中的作用，以及潜在的糖尿病预防计划，如IDUS人群，他们承担了丙型肝炎病毒流行的大部分负担。

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.