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，已经进行了数百项研究和调查，以确定其在吸毒者中的发病率。HCV流行病学的几个特征已经得到解决，包括它在注射吸毒者（IDUs）中的高地方性，以及它对公共卫生预防计划控制的抵抗力。由于近年来有如此多的HCV研究，出现了新的问题-如何综合已知的，解释不一致的，找到相似之处，并确定什么是未知的。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；可预防丙型肝炎病毒的易感期长短；吸烟或吸食毒品者感染丙型肝炎病毒的程度；以及注射吸毒者中HIV/HCV合并感染的程度和未来发展趋势。我们估计将有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）可用于本研究的分析，以系统地解决这些具体目标：利用来自美国和国外的数据，总结注射吸毒者和其他吸毒者中与人、地点和时间有关的HCV流行病学和预防。2. 检查观察到的HCV发病率和流行率是否因研究方法而异，如研究设计、抽样方法或随访时间长短。3. 描述hiv阳性注射吸毒者中HCV患病率的变化与人群特征、环境或研究时间段的关系。4. 根据已完成或正在进行的研究数量、调查范围以及表明研究差距的其他因素，描述吸毒者中丙型肝炎病毒的研究状况。丙型肝炎病毒是造成吸毒者和其他人疾病、残疾和死亡的重大负担的原因，在世界许多地区，注射吸毒者是社区丙型肝炎病毒的主要储藏库。与预防丙型肝炎病毒传播、满足丙型肝炎病毒和艾滋病毒/丙型肝炎病毒合并感染的医疗管理需求以及制定丙型肝炎病毒研究议程有关的公共卫生政策将以实现这些目标为指导。

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 We estimate that 800-1000 data reports (published articles, unpublished manuscripts, abstracts, presentations, and other reports) will be available for analysis in this study, to systematically address these specific aims: 1.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.