Synthesis: HCV Epidemiology and Prevention in Drug Users

描述（由申请人提供）：自1989年发现丙型肝炎病毒（HCV）以来，已进行了数百项研究和调查，以描述其在吸毒者中的发生情况。HCV流行病学的几个特征已经得到解决，包括其在注射吸毒者（IDUs）中的高度流行性，以及其对公共卫生预防计划控制的抵抗。由于近年来有这么多的HCV研究，出现了新的问题-如何综合已知的，解释不一致，找到相似之处，并确定什么是仍然未知的。在这个阶段需要进行荟萃分析，以调和关于可能影响传播的因素的相互矛盾的研究结果;对HCV易感的时间长度，何时可以进行预防;吸烟或吸食毒品者的HCV感染程度;以及注射吸毒者中HIV/HCV合并感染的程度和未来进程。我们估计本研究将有800-1000份数据报告（已发表的文章、未发表的手稿、摘要、演示文稿和其他报告）可供分析，以系统地解决这些特定目标：1.使用美国和国外的数据，总结注射和其他药物使用者中HCV的流行病学和预防，与人，地点和时间有关。2.检查观察到的HCV发病率和患病率以及相关性的测量是否与研究方法有关，如研究设计，抽样方法或随访时间。3.描述HIV阳性注射吸毒者中HCV流行率的变化与人群特征、研究环境或研究时间段的关系。4.描述关于吸毒者中HCV的研究状况，包括已完成或正在进行的研究数量、调查范围以及表明研究空白的其他因素。HCV是吸毒者和其他人的重大疾病负担、残疾和死亡的原因，在世界许多地区，注射吸毒者是社区中HCV的主要储存者。这些目标的实现将指导与预防HCV传播相关的公共卫生政策，满足HCV和HIV/HCV合并感染的医疗管理需求，以及制定HCV研究议程。

DESCRIPTION (provided by applicant): Since the discovery of hepatitis C virus (HCV) in 1989, hundreds of studies and surveys have been conducted to characterize its occurrence in drug users. Several features of HCV epidemiology have been resolved, including its hyper-endemicity in injection drug users (IDUs), and its resistance to control by public health prevention programs. Since there has been so much HCV research in recent years, new questions have arisen - how to synthesize what is known, explain inconsistencies, find similarities, and determine what is still unknown. A meta-analysis is needed at this stage to reconcile contradictory research findings regarding factors that may influence transmission; the length of the period of susceptibility to HCV, when prevention can occur; the extent of HCV infection in those who smoke or sniff drugs; and the magnitude and future course of HIV/HCV co-infection in IDUs. We estimate that 800-1000 data reports (published articles, unpublished manuscripts, abstracts, presentations, and other reports) will be available for analysis in this study, to systematically address these specific aims: 1. Summarize HCV epidemiology and prevention in injection and other drug users in relation to person, place and time, using data from the US and abroad. 2. Examine whether observed HCV incidence and prevalence, and measures of association vary in relation to research methodology, such as study design, sampling method or length of follow-up. 3. Describe variation in HCV prevalence among HIV-positive IDUs in relation to characteristics of the population, the setting, or time period of the study. 4. Describe the state of research on HCV in drug users in terms of the number of studies completed or underway, the scope of their investigation, and other factors that suggest research gaps. HCV is the cause of a substantial burden of disease, disability and death in drug users and others, and in many regions of the world, IDUs are the primary reservoir of HCV in the community. Public health policy related to preventing HCV transmission, meeting the demand for medical management of HCV and HIV/HCV co-infection, and setting the HCV research agenda would be guided by the accomplishment of these aims.