International Rescue Committee, Kabul, Afghanistan.
Int J Infect Dis. 2011 Mar;15(3):e201-5. doi: 10.1016/j.ijid.2010.11.006. Epub 2010 Dec 28.
To assess differences between injecting drug users (IDUs) with hepatitis C virus (HCV) viremia and IDUs with HCV antibody (Ab) or no evidence of prior infection in three Afghan cities.
IDUs in Hirat, Jalalabad, and Mazar-i-Sharif completed questionnaires and rapid testing for blood-borne infections including HCV Ab. HCV Ab was confirmed with a recombinant immunoblot assay (RIBA); RIBA-positive specimens underwent reverse transcriptase polymerase chain reaction (RT-PCR) for HCV. Risk behaviors associated with viremia were assessed with site-controlled ordinal regression analysis.
Of 609 participants, 223 (36.6%) had confirmed HCV Ab. Of 221 with serum available for PCR evaluation, 127 (57.5%) were viremic. HCV viremia prevalence did not differ by site (range 41.7-59.1%; p=0.52). Among all IDUs, in age and site-controlled ordinal regression analysis, HCV was independently associated with HIV co-infection (adjusted odds ratio (AOR) 7.16, 95% confidence interval (CI) 4.41-11.64), prior addiction treatment (AOR 1.95, 95% CI 1.57-2.42), ever aspirating and re-injecting blood (AOR 1.62, 95% CI 1.18-2.23), prior incarceration (AOR 1.60, 95% CI 1.04-2.45), and sharing injecting equipment in the last 6 months (AOR 1.35, 95% CI 1.02-1.80).
HCV viremia was present in many participants with prior HCV infection and was associated with some injecting risk behaviors, indicating a substantial risk for transmission. Current harm reduction programs should aim to improve HCV awareness and prevention among IDUs in Afghanistan as a matter of urgency.
评估在阿富汗三个城市中，丙型肝炎病毒（HCV）血症的吸毒者（IDU）与 HCV 抗体（Ab）或无既往感染证据的 IDU 之间的差异。
在赫拉特、贾拉拉巴德和马扎里沙里夫，IDU 完成了包括 HCV Ab 在内的血液传播感染的问卷和快速检测。HCV Ab 通过重组免疫印迹分析（RIBA）进行确认；RIBA 阳性标本进行逆转录聚合酶链反应（RT-PCR）检测 HCV。采用现场对照有序回归分析评估与病毒血症相关的风险行为。
在 609 名参与者中，223 名（36.6%）有明确的 HCV Ab。在 221 名有血清可供 PCR 评估的参与者中，127 名（57.5%）呈病毒血症。HCV 病毒血症的流行率不因地点而异（范围为 41.7-59.1%；p=0.52）。在所有 IDU 中，在年龄和地点对照有序回归分析中，HCV 与 HIV 合并感染（调整后的优势比（AOR）7.16，95%置信区间（CI）4.41-11.64）、既往戒毒治疗（AOR 1.95，95% CI 1.57-2.42）、既往抽吸和重新注射血液（AOR 1.62，95% CI 1.18-2.23）、既往监禁（AOR 1.60，95% CI 1.04-2.45）和最近 6 个月内共用注射设备（AOR 1.35，95% CI 1.02-1.80）有关。
许多有既往 HCV 感染的参与者存在 HCV 病毒血症，且与某些注射风险行为有关，表明传播风险很大。当前的减少伤害计划应紧急旨在提高阿富汗 IDU 对 HCV 的认识和预防。
