Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA.
Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA.
Curr HIV/AIDS Rep. 2018 Jun;15(3):245-254. doi: 10.1007/s11904-018-0393-0.
This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic.
Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.
本文回顾了 HIV 和丙型肝炎病毒（HCV）的最新流行病学趋势，以及与阿片类药物流行相关的这些感染的治疗和预防策略。
在美国（US），注射吸毒者（PWID）中的 HIV 诊断病例正在减少，而 HCV 则在增加。HIV 和 HCV 的护理严重依赖于专家基础设施，而农村地区缺乏这种基础设施。抗逆转录病毒药物和直接作用抗病毒药物对 PWID 有效，但多种障碍使农村注射者难以获得这些治疗。同样，农村地区获得注射器服务项目、阿片类药物成瘾的药物辅助治疗和 HIV 暴露前预防的机会也受到限制。以前针对 PWID 的 HIV 和 HCV 的研究主要集中在城市或国际人群，但美国的阿片类药物流行正在远离大都市中心。阿片类药物注射的农村化程度增加带来了治疗和预防方面的独特挑战。迫切需要研究农村人群中 HIV、HCV 和阿片类药物使用障碍的护理。
