Quan Vu Minh, Go Vivian F, Nam Le Van, Bergenstrom Anna, Thuoc Nguyen Phuong, Zenilman Jonathan, Latkin Carl, Celentano David D
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
AIDS Care. 2009 Jan;21(1):7-16. doi: 10.1080/09540120802017610.
Injection drug use (IDU) and HIV infection are important public health problems in Vietnam. The IDU population increased 70% from 2000 to 2004 and is disproportionately affected by HIV and AIDS -- the country's second leading cause of death. Hepatitis B virus (HBV) and hepatitis C virus (HCV) share transmission routes with HIV and cause serious medical consequences. This study aimed to determine risk factors for acquisition of HIV, HBV, and HCV infections among IDUs in a northern province. We conducted a matched case-control study among active IDUs aged 18-45 who participated in a community-based survey (30-minute interview and serologic testing). Each HIV-infected IDU (case) was matched with one HIV-uninfected IDU (control) by age, sex (males only), and study site (128 pairs). Similar procedures were used for HBV infection (50 pairs) and HCV infection (65 pairs). Conditional logistic regression models were fit to identify risk factors for each infection. Among 309 surveyed IDUs, the HIV, HBV, and HCV prevalence was 42.4%, 80.9%, and 74.1%, respectively. Only 11.0% reported having been vaccinated against hepatitis B. While 13.3% of the IDUs reported sharing needles (past six months), 63.8% engaged in indirect sharing practices (past six months), including sharing drug solutions, containers, rinse water, and frontloading drugs. In multivariable models, sharing drugs through frontloading was significantly associated with HIV infection (odds ratio [OR]=2.8), HBV infection (OR=3.8), and HCV infection (OR=4.6). We report an unrecognized association between sharing drugs through frontloading and higher rates of HIV, HBV and HCV infections among male IDUs in Vietnam. This finding may have important implications for bloodborne viral prevention for IDUs in Vietnam.
注射吸毒和艾滋病毒感染是越南重要的公共卫生问题。2000年至2004年期间，注射吸毒人群增加了70%，且受艾滋病毒和艾滋病的影响尤为严重，这是该国第二大死因。乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）与艾滋病毒有共同的传播途径，并会导致严重的医学后果。本研究旨在确定北部一个省份注射吸毒者感染艾滋病毒、HBV和HCV的危险因素。我们在18至45岁参与社区调查（30分钟访谈和血清学检测）的活跃注射吸毒者中开展了一项匹配病例对照研究。每例感染艾滋病毒的注射吸毒者（病例）按年龄、性别（仅限男性）和研究地点与一名未感染艾滋病毒的注射吸毒者（对照）匹配（128对）。对HBV感染（50对）和HCV感染（65对）采用类似程序。采用条件逻辑回归模型确定每种感染的危险因素。在309名接受调查的注射吸毒者中，艾滋病毒、HBV和HCV的患病率分别为42.4%、80.9%和74.1%。只有11.0%的人报告接种过乙肝疫苗。虽然13.3%的注射吸毒者报告有共用针头行为（过去六个月内），但63.8%的人有间接共用行为（过去六个月内），包括共用毒品溶液、容器、冲洗水和预先装载毒品。在多变量模型中，通过预先装载毒品共用与艾滋病毒感染（比值比[OR]=2.8）、HBV感染（OR=3.8）和HCV感染（OR=4.6）显著相关。我们报告了越南男性注射吸毒者通过预先装载毒品共用与艾滋病毒、HBV和HCV感染率较高之间存在未被认识到的关联。这一发现可能对越南注射吸毒者的血源病毒预防具有重要意义。
