National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain.
National School of Public Health, Carlos III Health Institute, Madrid, Spain.
J Epidemiol Community Health. 2015 Jun;69(6):599-603. doi: 10.1136/jech-2014-205070. Epub 2015 Apr 13.
Cohort studies on hepatitis C virus (HCV) among drug injectors are scarcer than studies on HIV. Combined harm reduction interventions (HRIs) can prevent HCV infection. Spain has a medium-high coverage of HRIs.
513 young heroin users who injected drugs in the past 12 months (recent injectors) were street-recruited in 2001-2003 and followed until 2006 in three Spanish cities; 137 were anti-HCV seronegative, 77 of whom had ≥1 follow-up visit. Dried blood spots were tested for anti-HCV. HCV incidence and predictors of infection were estimated using Poisson models.
At baseline, 73% were anti-HCV positive. Overall incidence (n=77) of HCV seroconversion was 39.8/100 person-years (py) (95% CI 28.7 to 53.8). Excluding non-injectors during follow-up from the analysis (n=57), HCV incidence was 52.9/100 py (95% CI 37.4 to 72.5). Injecting at least weekly (incidence rate ratio (IRR)=5.2 (95% CI 2.5 to 11.1)) and having ≥2 sexual partners (IRR=2.2 (95% CI 1.1 to 4.7)) were independent predictors of HCV seroconversion; drug-injection history <2 years was marginally associated (IRR=2.4 (95% CI 0.9 to 4.7)). HCV incidence may have been underestimated due to differential attrition.
Despite fairly high HRI coverage among Spanish drug injectors, a distressingly high incidence of HCV in a context of high HCV prevalence was found among young heroin injectors.
与 HIV 研究相比，针对吸毒者的丙型肝炎病毒（HCV）的队列研究较为少见。联合减少危害干预（HRIs）可以预防 HCV 感染。西班牙的 HRIs 覆盖率处于中高水平。
2001-2003 年，在西班牙三个城市街头招募了 513 名过去 12 个月内曾注射过毒品的年轻海洛因使用者（近期注射者），并随访至 2006 年；其中 137 名抗 HCV 血清阴性，其中 77 名至少有 1 次随访。通过检测干血斑来检测抗 HCV。使用泊松模型估计 HCV 感染的发生率和预测因素。
基线时，73%的人抗 HCV 阳性。总体（n=77） HCV 血清转化率为 39.8/100 人年（py）（95%CI 28.7 至 53.8）。在分析中排除随访期间不注射的人（n=57），HCV 发病率为 52.9/100 py（95%CI 37.4 至 72.5）。每周至少注射一次（发病率比（IRR）=5.2（95%CI 2.5 至 11.1））和有≥2 个性伴侣（IRR=2.2（95%CI 1.1 至 4.7））是 HCV 血清转化率的独立预测因素；吸毒史<2 年与 HCV 血清转化率略有相关（IRR=2.4（95%CI 0.9 至 4.7））。由于不同的人员流失，HCV 发病率可能被低估。
尽管西班牙吸毒者的 HRIs 覆盖率相当高，但在 HCV 流行率较高的情况下，年轻的海洛因注射者 HCV 发病率却高得令人担忧。
