Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.
J Viral Hepat. 2019 Dec;26(12):1413-1422. doi: 10.1111/jvh.13194. Epub 2019 Sep 11.
Hepatitis C virus (HCV) acquisition remains high in key risk environments including injection drug use and sex between men. However, few studies examine the independent contribution of sexual behaviour to HCV acquisition among people who inject drugs (PWID). We estimated HCV incidence and examined sexual behaviour as a time-varying predictor of HCV acquisition in a prospective cohort study of PWID in Montreal (2004-2017). Initially, HCV-negative participants completed behavioural questionnaires and HCV antibody testing (6 months until 2011, 3 months thereafter). A time-updating exposure variable (no sex, opposite-sex partner only, ≥1 same-sex partner) was generated for the previous 6/3 months. Time to HCV seroconversion was examined using Cox regression analysis, adjusted for age, unstable housing and incarceration (both past 3 months), and daily, heroin, cocaine and prescription opioid injecting (all past month). Among 440 PWID (baseline: median age 33 years, 18.9% female, 1.4% HIV-positive), 156 participants seroconverted during follow-up (overall incidence rate: 11.9/100 person-years [PY]). Incidence was lowest in the no sex group (8.70 and 2.91 cases/100 PY in males and females, respectively) and highest in the ≥1 same-sex partner group (24.14 and 21.97 cases/100 PY in males and females, respectively). Among males, HCV risk was 47% lower in those reporting no sex compared to ≥1 same-sex partner (adjusted hazard ratio: 0.53, 95% confidence interval: 0.28, 0.99). In this cohort of PWID, reporting recent same-sex partners was associated with greater risk of HCV acquisition among males, necessitating targeted harm reduction strategies that consider the complex interplay of sexual and injecting risk behaviours.
丙型肝炎病毒（HCV）在包括注射吸毒和男男性行为在内的关键风险环境中仍然高发。然而，很少有研究调查性行为在注射吸毒者（PWID）中HCV 感染中的独立作用。我们在蒙特利尔的一项前瞻性 PWID 队列研究中估计了 HCV 的发病率，并调查了性行为作为 HCV 感染的时间变化预测因子。最初，HCV 阴性参与者完成了行为问卷和 HCV 抗体检测（6 个月至 2011 年，此后 3 个月）。为过去 6/3 个月生成了一个时间更新的暴露变量（无性行为、仅异性伴侣、≥1 名同性伴侣）。使用 Cox 回归分析检查 HCV 血清转换时间，调整了年龄、不稳定住房和监禁（过去 3 个月）以及每天、海洛因、可卡因和处方类阿片类药物注射（过去 1 个月）。在 440 名 PWID（基线：中位年龄 33 岁，18.9%为女性，1.4%为 HIV 阳性）中，156 名参与者在随访期间发生了血清转换（总发病率：11.9/100 人年[PY]）。无性行为组的发病率最低（男性和女性分别为 8.70 和 2.91 例/100 PY），≥1 名同性伴侣组的发病率最高（男性和女性分别为 24.14 和 21.97 例/100 PY）。在男性中，与≥1 名同性伴侣相比，报告无性行为的 HCV 风险降低 47%（调整后的危险比：0.53，95%置信区间：0.28，0.99）。在该队列中，报告最近的同性伴侣与男性 HCV 感染风险增加有关，需要有针对性的减少伤害策略，考虑性行为和注射风险行为的复杂相互作用。
