注射吸毒者（PWID）和男男性行为艾滋病毒阳性者（HIV+ MSM）中丙型肝炎病毒（HCV）感染的自发病毒清除：一项系统评价和荟萃分析。
Spontaneous viral clearance of hepatitis C virus (HCV) infection among people who inject drugs (PWID) and HIV-positive men who have sex with men (HIV+ MSM): a systematic review and meta-analysis.
作者信息
Smith Daniel J, Jordan Ashly E, Frank Mayu, Hagan Holly
机构信息
Rory Meyers College of Nursing, New York University, New York, NY, 10010, USA.
Center for Drug Use and HIV Research, New York University, New York, NY, 10010, USA.
出版信息
BMC Infect Dis. 2016 Sep 5;16(1):471. doi: 10.1186/s12879-016-1807-5.
BACKGROUND
Hepatitis C virus (HCV) infection causes significant morbidity and mortality among people who inject drugs (PWID) and HIV+ men who have sex with men (MSM). Characterizing spontaneous viral clearance of HCV infection among PWID and HIV+ MSM is important for assessing the burden of disease and treatment strategies in these populations.
METHODS
Electronic and other searches of medical literature were conducted. Reports were eligible if they presented original data from upper-middle- and high-income countries on laboratory-confirmed HCV infection and spontaneous viral clearance among PWID or HIV+ MSM. Pooled estimates of spontaneous viral clearance were generated using fixed-effect and random-effects models. Meta-regression examined potential predictors related to individual characteristics and research methodology.
RESULTS
The meta-analysis estimated that spontaneous viral clearance occurs in 24.4 % of PWID and 15.4 % of HIV+ MSM. In univariate meta-regression among PWID, male sex and age were significantly associated with spontaneous viral clearance, and in multivariate analysis, male sex and HIV positivity were predictors of spontaneous viral clearance; among HIV+ MSM no variables were found to affect spontaneous viral clearance.
CONCLUSION
The variability in estimates of spontaneous viral clearance between HIV+ MSM and PWID suggests the impact of HIV co-infection and HCV re-infection. Due to limited data on additional factors that may affect the natural history of HCV, more research is needed to further understand spontaneous viral clearance in these risk groups.
PROTOCOL REGISTRATION
The protocols for the PWID and HIV+ MSM research were registered with PROSPERO (CRD42014008805; CRD42013006462).
背景
丙型肝炎病毒（HCV）感染在注射吸毒者（PWID）以及感染人类免疫缺陷病毒（HIV）的男男性行为者（MSM）中导致了显著的发病率和死亡率。了解PWID和HIV阳性MSM中HCV感染的自发病毒清除情况对于评估这些人群的疾病负担和治疗策略至关重要。
方法
对医学文献进行了电子检索和其他检索。如果报告提供了来自中高收入国家关于实验室确诊的HCV感染以及PWID或HIV阳性MSM中自发病毒清除的原始数据，则这些报告符合纳入标准。使用固定效应模型和随机效应模型生成自发病毒清除的合并估计值。Meta回归分析了与个体特征和研究方法相关的潜在预测因素。
结果
Meta分析估计，24.4%的PWID和15.4%的HIV阳性MSM会出现自发病毒清除。在PWID的单变量Meta回归中，男性和年龄与自发病毒清除显著相关，多变量分析中，男性和HIV阳性是自发病毒清除的预测因素；在HIV阳性MSM中，未发现有变量影响自发病毒清除。
结论
HIV阳性MSM和PWID之间自发病毒清除估计值的差异表明了HIV合并感染和HCV再感染的影响。由于关于可能影响HCV自然史的其他因素的数据有限，需要更多研究来进一步了解这些风险人群中的自发病毒清除情况。
方案注册
PWID和HIV阳性MSM研究的方案已在国际前瞻性系统评价注册库（PROSPERO）注册（CRD42014008805；CRD42013006462）。
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