HEPATITIS C IN NEW IDUS: IMPLICATIONS FOR HIV PREVENTION

在一项近期注射药物的前瞻性研究中， 对注射吸毒者和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（HCV）感染的三个主要问题： 1)是间接共享（例如，共享棉花，炊具）的风险 在注射吸毒者中，2）正在共用吸烟/吸食毒品的工具（例如，吸管） 与NICHUs中的HCV相关，以及3）由于HCV清除不常见（原文如此）， 哪些病毒/宿主因素与清除相关？解决这些 问题，我们将招募450名新的注射吸毒者（> 15岁，< 1注射）和200名 利用外联技术的国家土著居民住房中心。在基线时，我们将进行HCV、HIV和 应用音频计算机进行B型肝炎血清学及危险行为确定 辅助自我访谈（ACASI）;将使用 逻辑回归注射吸毒者将每隔2个月随访一次， 静脉穿刺，以确定丙型肝炎病毒（使用抗体测试和 HCV-PCR）和使用ACASI获得的危险行为。在分析中，行为之后 单独考虑，将使用多个 纵坐标风险技术：HCV感染的风险因素将使用生存率 方法.将通过HCV-PCR测定HCV清除率。病毒检测 将对所有新的HCV病例进行序列分析和宿主遗传标记 以及持续性HCV感染者与 清除了病毒就可以了因为HCV感染通常先于HCV 研究注射吸毒者首次感染艾滋病毒的风险， 开始注射将为社区工作者瞄准这一目标提供方向 早期弱势群体。此外，这项研究将提供关键的 NIH管理共识发展声明 确定需要进一步研究的丙型肝炎：1）传播方式 药物滥用者中HCV感染率和2）缺乏HCV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.