Department of Infectious Diseases, Division of Clinical Sciences, Lund University, Malmö, Sweden.
J Viral Hepat. 2011 Dec;18(12):831-9. doi: 10.1111/j.1365-2893.2010.01400.x. Epub 2010 Nov 29.
The aim of this study was to examine the prevalence and incidence of HIV and hepatitis B and C (HBV and HCV) among injecting drug users in a Swedish needle exchange programme (NEP) and to identify risk factors for blood-borne transmission. A series of serum samples from NEP participants enrolled from 1997 to 2005 were tested for markers of HIV, HBV and HCV (including retrospective testing for HCV RNA in the last anti-HCV-negative sample from each anti-HCV seroconverter). Prevalence and incidence were correlated with self-reported baseline characteristics. Among 831 participants available for follow-up, one was HIV positive at baseline and two seroconverted to anti-HIV during the follow-up of 2433 HIV-negative person-years [incidence 0.08 per 100 person-years at risk (pyr); compared to 0.0 in a previous assessment of the same NEP covering 1990-1993]. The corresponding values for HBV were 3.4/100 pyr (1990-1993: 11.7) and for HCV 38.3/100 pyr (1990-1993: 27.3). HCV seroconversions occurred mostly during the first year after NEP enrolment. Of the 332 cases testing anti-HCV negative at enrolment, 37 were positive for HCV RNA in the same baseline sample (adjusted HCV incidence 31.5/100 pyr). HCV seroconversion during follow-up was significantly associated with mixed injection use of amphetamine and heroin, and a history of incarceration at baseline. In this NEP setting, HIV prevalence and incidence remained low and HBV incidence declined because of vaccination, but transmission of HCV was persistently high. HCV RNA testing in anti-HCV-negative NEP participants led to more accurate identification of timepoints for transmission.
本研究旨在调查瑞典针具交换项目（NEP）中注射吸毒者中 HIV 和乙型肝炎（HBV）和丙型肝炎（HCV）的流行率和发生率，并确定血液传播的危险因素。从 1997 年至 2005 年期间纳入 NEP 参与者的一系列血清样本，对 HIV、HBV 和 HCV 的标志物进行了检测（包括对每位 HCV 抗体转阳者的最后一个 HCV 抗体阴性样本进行 HCV RNA 的回顾性检测）。将流行率和发生率与自我报告的基线特征相关联。在 831 名可进行随访的参与者中，1 名参与者在基线时 HIV 阳性，2 名参与者在随访的 2433 名 HIV 阴性人年中 HIV 抗体转阳[发病率为每 100 人年 0.08（pyr）；而在前一次对同一 NEP 的评估中，该值在 1990-1993 年为 0.0]。HBV 的相应值为 3.4/100 pyr（1990-1993 年：11.7），HCV 为 38.3/100 pyr（1990-1993 年：27.3）。HCV 抗体转阳主要发生在 NEP 登记后的第一年。在 332 名登记时 HCV 抗体阴性的病例中，37 名在同一基线样本中 HCV RNA 阳性（调整后的 HCV 发病率为 31.5/100 pyr）。随访期间的 HCV 抗体转阳与混合使用苯丙胺和海洛因以及基线时被监禁的病史显著相关。在这种 NEP 环境下，HIV 的流行率和发病率仍然较低，HBV 的发病率因疫苗接种而下降，但 HCV 的传播率一直很高。对 NEP 参与者中 HCV 抗体阴性者进行 HCV RNA 检测，可更准确地确定传播时间点。
