Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK.
J Med Virol. 2012 Nov;84(11):1737-43. doi: 10.1002/jmv.23389.
Injecting drug users are the principal at risk group for blood borne viruses. The aim was to assess the feasibility of screening substance misusers for blood borne viruses, and to offer appropriate vaccinations/referral to hepatology services. This was a nurse led prospective 6-month study based at a large Substance Misuse Service in south east England. Of the 196 consecutive individuals assessed, 81 were eligible for HBV immunization of whom only 33.3% completed a vaccination course. Prevalence of positive serological markers were: anti-HBc 14.4%, HBsAg 1.5%, and HCV antibody 37.9%. Compared to men, women were more likely to accept blood borne virus testing (83.3% vs. 62.3%), have ever injected (89.6% vs. 76.3%), overdose (54.2% vs. 23.6%), be anti-HBc positive (27.5% vs. 8.8%), drink alcohol above national recommended guidelines (41.7% vs. 25.7%), and have a positive HCV serology (55% vs. 30.4%) (P ≤ 0.05 for all). Of the 73 individuals identified with a positive HBsAg and or HCV antibody, only 14 (19.1%) were known to hepatology services and 8 (20%) of those eligible subsequently accepted a specialist referral. In conclusion, serological markers for blood borne viruses remain high in substance misusers (anti-HBc 14.4%, HCV antibody 37.9%), with women more likely to be positive. Overall, only 33.3% and 20%, respectively, complete HBV vaccination and accept a hepatology referral. A multidisciplinary approach is paramount to address both the blood borne viruses and the substance misuse and realignment of hepatitis services to Substance Misuse Services may offer such a strategy.
注射吸毒者是血液传播病毒的主要高危人群。本研究旨在评估对物质滥用者进行血液传播病毒筛查的可行性，并为其提供适当的疫苗接种/转介至肝病服务。这是一项在英格兰东南部一家大型物质滥用服务机构中由护士主导的前瞻性 6 个月研究。在评估的 196 名连续个体中，有 81 名符合乙型肝炎病毒免疫接种条件，但仅有 33.3%完成了疫苗接种疗程。阳性血清学标志物的患病率为：抗-HBc 14.4%、HBsAg 1.5%和 HCV 抗体 37.9%。与男性相比，女性更有可能接受血液传播病毒检测（83.3%对 62.3%）、曾经注射过（89.6%对 76.3%）、过量用药（54.2%对 23.6%）、抗-HBc 阳性（27.5%对 8.8%）、饮酒量超过国家推荐指南（41.7%对 25.7%）和 HCV 血清学阳性（55%对 30.4%）（所有 P 值均≤0.05）。在 73 名被确定为 HBsAg 和/或 HCV 抗体阳性的个体中，仅有 14 名（19.1%）已知在肝病服务机构中，在符合条件的个体中，有 8 名（20%）随后接受了专科转介。总之，物质滥用者的血液传播病毒血清学标志物仍然很高（抗-HBc 14.4%、HCV 抗体 37.9%），女性更有可能呈阳性。总体而言，分别只有 33.3%和 20%完成乙型肝炎病毒疫苗接种并接受肝病转介。多学科方法对于解决血液传播病毒和物质滥用问题至关重要，将肝炎服务重新调整至物质滥用服务机构可能是一种策略。
