HEPATITIS C IN NEW IDUS: IMPLICATIONS FOR HIV PREVENTION

在最近注射毒品的前瞻性研究的背景下 以及对非注射可卡因和海洛因使用者的调查， 我们建议解决有关丙型肝炎(丙型肝炎)感染的三个主要问题： 1)间接共用(例如，共用棉花、炊具)是否有发生丙型肝炎病毒的风险 在注射吸毒者中，2)共享吸烟/吸食毒品的工具(例如吸管) 在NICHU中与丙型肝炎病毒相关，以及3)因为丙型肝炎病毒清除不常见(SIC)， 哪些病毒/宿主因素与清除有关？要解决这些问题 问题，我们将招募450名新的静脉吸毒者(15岁，1名注射)和200名 使用外展技术的NICHU。在基线上，我们将进行丙型肝炎病毒、艾滋病毒和 利用有声计算机进行乙肝病毒血清学检测和危险行为确定 辅助自我访谈(ACASI)；感染的相关因素将使用 Logistic回归。注射吸毒者将每隔2个月接受一次 静脉穿刺法确定丙型肝炎病毒感染病例(使用抗体检测和 丙型肝炎病毒聚合酶链式反应)和使用ACASI获得的危险行为。在分析中，在行为之后 单独考虑时，将使用多个 协调风险技术：丙型肝炎病毒感染的风险因素将使用存活率 方法：研究方法。丙型肝炎病毒的清除将通过丙型肝炎病毒聚合酶链式反应来确定。病毒检测 将对所有新的丙型肝炎病毒病例进行序列分析和宿主遗传标记 以及持续感染丙型肝炎病毒的人与 已经清除了病毒的人就会完成。因为丙型肝炎病毒感染通常先于丙型肝炎病毒 和注射吸毒者中的艾滋病毒感染研究注射吸毒者第一次感染的风险 开始注入将为社区工作者提供方向，以针对这一点 弱势群体很早就出现了。此外，这项研究将提供关键的 NIH关于管理的共识发展声明在两个领域的信息 被认为需要进一步研究的丙型肝炎：1)传播方式 药物滥用者中的丙型肝炎病毒感染率和2)丙型肝炎病毒未被清除的原因。

In the context of a prospective study of recent injection drug users (IDUs) and a survey of non-injection cocaine and heroin users (NICHUs), we propose to address three major questions about hepatitis C (HCV) infection: 1) is indirect sharing (e.g., sharing cotton, cookers) a risk for incident HCV in IDUs, 2) is sharing implements for smoking/snorting drugs (e.g., straws) associated with HCV in NICHUs, and 3) because HCV clearance in uncommon (sic), what viral/host factors are associated with clearance? To address these questions, we will recruit 450 new IDUs (> 15 years old, < 1 injecting) and 200 NICHUs using outreach techniques. At baseline we will perform HCV, HIV and hepatitis B (HBV) serology and ascertain risk behaviors using audio computer assisted self-interview (ACASI); correlates of infection will be analyzed using logistic regression. IDUs will be followed at 2 month intervals with venipuncture to identify incident cases of HCV (using antibody test and HCV-PCR) and risk behaviors obtained using ACASI. In analyses, after behaviors are considered separately, a risk profile will be developed using Multiple Ordinate Risk techniques: risk factors for HCV infection will use survival methods. Clearance of HCV will be determined by HCV-PCR. Testing by viral sequence analyses and host genetic markers will be done on all new cases of HCV and comparisons between persons with persistent HCV infection and those who have cleared the virus will be done. Because HCV infection usually precedes HCV and HIV infection in IDUs study risk of infection among IDUs when they first begin to inject will provide direction for community workers to target this vulnerable population early. Additionally, this study will provide critical information in two areas that NIH Consensus Development Statement on Management of Hepatitis C identified as needing further research: 1) modes of transmission of HCV among substance abusers and 2) reasons for lack of HCV clearance.