在亚马逊地区多个地点使用非法药物的人群中，丙型肝炎病毒感染状况及其相关因素。
Hepatitis C virus infection status and associated factors among a multi-site sample of people who used illicit drugs in the Amazon region.
机构信息
Laboratório de Células e Patógenos, Grupo de Estudo e Pesquisa em Populações Vulneráveis (GEPPOV), Instituto de Estudos Costeiros, Campus de Bragança, Universidade Federal do Pará, Alameda Leandro Ribeiro, s/n. Aldeia, Bragança, PA, Brazil.
Laboratório de Patologia Clínica de Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil.
出版信息
BMC Infect Dis. 2019 Jul 17;19(1):634. doi: 10.1186/s12879-019-4270-2.
BACKGROUND
Elevated rates of Hepatitis C Virus (HCV) infection have been reported in epidemiological studies with people who used illicit drugs (PWUIDs) in different Brazilian regions. In Brazil's Amazon region, studies have already identified the common use of illicit drugs among adolescents and the high prevalence of HCV infections among PWUIDs. However, all studies done with PWUIDs were conducted with small samples and within limited geographic coverage. This study determined the prevalence and risk factors for HCV infection in PWUIDs in the Amazon region, northern Brazil, as well as estimating the prevalence and factors associated with the HCV spontaneous clearance (HSC).
METHODS
This cross-sectional study accessed 1666 PWUIDs from multiple municipalities of the Amazon region. Socio-demographic, economic, drug use and health-related information were collected through interviews. Blood samples collected were tested for the presence of anti-HCV antibodies and RNA-HCV. HCV genotypes were identified by real-time polymerase chain reaction (PCR). Logistic regressions were run to identify factors independently associated with HCV infection status and HSC.
RESULTS
In total, 577 (34.6%) featured HCV antibodies, of which 384 (23.1%) had active HCV infection and 193 (11.6%) indicated HSC. Genotypes 1 (80.2%) and 3 (18.8%) were detected. HCV infection status was associated with the length of illicit drug use history, factors related to parenteral and sexual transmission, and factors of socio-economic marginalization leading to potential risk activities for HCV. HSC was associated with the ethnic (including indigenous) background of participants.
CONCLUSIONS
High levels of HCV infection were detected in PWUIDs. Genotype 1 was predominant. Intense use of illicit drugs, unprotected sexual intercourse, high number of sexual partners and social marginalization were associated with all HCV infection. HSC was associated with origin (Amazonian-born) and non-white (e.g., Black or Indigenous) of PWUIDs. These findings emphasize the need for improve HCV prevention and control services and care for PWUIDs in the Brazilian Amazon region.
背景
在巴西不同地区进行的流行病学研究中，曾报道过使用非法药物的人群（PWUID）中丙型肝炎病毒（HCV）感染率升高。在巴西亚马逊地区，已有研究表明青少年普遍存在使用非法药物的现象，且 PWUID 中 HCV 感染率较高。然而，所有针对 PWUID 进行的研究均采用小样本，且仅在有限的地理区域内进行。本研究旨在确定巴西亚马逊地区 PWUID 中 HCV 感染的流行率和危险因素，并估计 HCV 自发清除（HSC）的流行率和相关因素。
方法
本横断面研究共纳入了来自亚马逊地区多个城市的 1666 名 PWUID。通过访谈收集了社会人口统计学、经济、药物使用和健康相关信息。采集血样检测抗 HCV 抗体和 RNA-HCV。通过实时聚合酶链反应（PCR）鉴定 HCV 基因型。进行逻辑回归分析，以确定与 HCV 感染状态和 HSC 独立相关的因素。
结果
共发现 577 名（34.6%）抗 HCV 抗体阳性者，其中 384 名（23.1%）为 HCV 现症感染者，193 名（11.6%）为 HCV 自发清除者。检测到基因型 1（80.2%）和 3（18.8%）。HCV 感染状态与非法药物使用史的长短、与注射和性传播相关的因素以及导致 HCV 潜在高危行为的社会经济边缘化因素有关。HSC 与参与者的种族（包括土著）背景有关。
结论
在 PWUID 中发现了高水平的 HCV 感染。主要基因型为 1 型。频繁使用非法药物、无保护性行为、性伴侣数量多和社会边缘化与所有 HCV 感染有关。HSC 与 PWUID 的原籍（亚马逊本地人）和非白人（如黑人或土著人）有关。这些发现强调了需要改善巴西亚马逊地区 PWUID 的 HCV 预防和控制服务以及护理。
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