Centre de Recherche Public de la Santé, Luxembourg.
BMC Public Health. 2011 May 19;11:351. doi: 10.1186/1471-2458-11-351.
In Luxembourg, viral hepatitis and HIV infection data in problem drug users (PDUs) are primarily based on self-reporting. Our study aimed to determine the prevalence of HAV, HBV, HCV and HIV infections in ever injecting (IDUs) and non-injecting drug users (nIDUs) including inherent risk factors analysis for IDUs. Secondary objectives were immunisation against HAV and HBV, referral to care and treatment facilities as well as reduction in risk behaviour.
A nationwide, cross-sectional multi-site survey, involving 5 in-, 8 out-treatment and 2 prison centres, included both an assisted questionnaire (n = 368) and serological detection of HIV and Hepatitis A, B, C (n = 334). A response rate of 31% resulted in the participation of 310 IDUs and 58 nIDUs. Risk factors such as drug use, sexual behaviour, imprisonment, protection and health knowledge (HAV, HBV status and immunisations, HCV, HIV), piercing/tattoo and use of social and medical services were studied by means of chi2 and logistic models.
Seroprevalence results for IDUs were 81.3% (218/268, 95%CI=[76.6; 86.0]) for HCV, 29.1% (74/254, 95%CI=[25.5;34.7 ]) for HBV (acute/chronic infection or past cured infection), 2.5% (5/202, 95%CI=[0.3; 4.6]) for HIV-1 and 57.1% (108/189, 95%CI=[50.0; 64.1]) for HAV (cured infections or past vaccinations). Seroprevalence results for nIDUs were 19.1% (9/47, 95%CI=[7.9;30.3]) for HCV, 8.9% (4/45, 95%CI=[0.6;17.2]) for HBV (acute/chronic infection or past cured infection), 4.8% (2/42, 95%CI=[-1.7;11.3]) for HIV-1 and 65.9% (27/41, 95%CI=[51.4;80.4]) for HAV. Prisoners showed the highest rates for all infections. Age, imprisonment and setting of recruitment were statistically associated with HCV seropositivity. Age, speedball career and nationality were significantly associated with HBV seropositivity. Only 56% of the participants in outpatient centres collected their serology results and 43 doses of vaccine against HAV and/or HBV were administered.
Despite the existing national risk-reduction strategies implemented since 1993, high prevalence of HCV and HBV infections in injecting drug users is observed. Our study showed that implementing risk-prevention strategies, including immunisation remains difficult with PDUs. Improvement should be looked for by the provision of field healthcare structures providing tests with immediate results, advice, immunisation or treatment if appropriate.
在卢森堡，病毒性肝炎和艾滋病毒感染数据主要基于问题吸毒者（PDU）的自我报告。我们的研究旨在确定既往注射吸毒者（IDU）和非注射吸毒者（nIDU）中甲型肝炎、乙型肝炎、丙型肝炎和艾滋病毒感染的流行率，包括对 IDU 固有风险因素的分析。次要目标是预防甲型肝炎和乙型肝炎，以及转介至护理和治疗设施，同时减少风险行为。
一项全国性、多地点的横断面研究，涉及 5 个门诊、8 个门诊和 2 个监狱中心，包括辅助问卷（n=368）和血清学检测艾滋病毒和甲型、乙型、丙型肝炎（n=334）。31%的应答率导致 310 名 IDU 和 58 名 nIDU 参与。通过卡方和逻辑模型研究了吸毒、性行为、监禁、保护和健康知识（甲型、乙型肝炎状态和免疫接种、丙型肝炎、艾滋病毒）、穿孔/纹身以及使用社会和医疗服务等风险因素。
IDU 的血清阳性率结果为 81.3%（218/268，95%CI=[76.6；86.0]）为丙型肝炎，29.1%（74/254，95%CI=[25.5；34.7]）为乙型肝炎（急性/慢性感染或既往治愈感染），2.5%（5/202，95%CI=[0.3；4.6]）为艾滋病毒-1，57.1%（108/189，95%CI=[50.0；64.1]）为甲型肝炎（治愈感染或既往疫苗接种）。nIDU 的血清阳性率结果为 19.1%（9/47，95%CI=[7.9；30.3]）为丙型肝炎，8.9%（4/45，95%CI=[0.6；17.2]）为乙型肝炎（急性/慢性感染或既往治愈感染），4.8%（2/42，95%CI=[-1.7；11.3]）为艾滋病毒-1，65.9%（27/41，95%CI=[51.4；80.4]）为甲型肝炎。囚犯的所有感染率最高。年龄、监禁和招募地点与丙型肝炎血清阳性率具有统计学关联。年龄、冰毒海洛因混合使用史和国籍与乙型肝炎血清阳性率显著相关。只有 56%的门诊中心参与者收集了他们的血清学结果，接种了 43 剂甲型肝炎和/或乙型肝炎疫苗。
尽管自 1993 年以来实施了国家减少风险战略，但仍观察到注射吸毒者中丙型肝炎和乙型肝炎感染的高流行率。我们的研究表明，实施预防策略，包括免疫接种，对问题吸毒者来说仍然很困难。应通过提供提供即时结果的现场医疗保健结构，提供咨询、免疫接种或治疗（如有必要），寻求改善。
