潜在器官捐献者中感染血源病毒的残余风险：系统评价和荟萃分析。

Residual risk of infection with blood-borne viruses in potential organ donors at increased risk of infection: systematic review and meta-analysis.

机构信息

University of Sydney, Sydney, NSW.

NSW Health Pathology, Prince of Wales Hospital and Community Health Services, Sydney, NSW.

出版信息

Med J Aust. 2019 Nov;211(9):414-420. doi: 10.5694/mja2.50315. Epub 2019 Sep 5.

DOI:10.5694/mja2.50315

PMID:31489635

Abstract

OBJECTIVE

To estimate the prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among people at increased risk of infection in Australia; to estimate the residual risk of infection among potential solid organ donors in these groups when their antibody and nucleic acid test results are negative.

STUDY DESIGN

Systematic review and meta-analysis of reports of the incidence and prevalence of HIV, HCV, and HBV in groups at increased risk of infection in Australia.

DATA SOURCES

MEDLINE, government and agency reports, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine conference abstracts, the Australian New Zealand Clinical Trial Registry, and National Health and Medical Research Council grants published 1 January 2000 - 14 February 2019; personal communications.

DATA SYNTHESIS

Residual risk of HIV infection was highest among men who have sex with men (4.8 [95% CI, 2.7-6.9] per 10 000 antibody-negative persons; 1.5 [95% CI, 0.9-2.2] per 10 000 persons who are both antibody- and nucleic acid-negative). Residual risk of HCV infection was highest among injecting drug users (289 [95% CI, 191-385] per 10 000 antibody-negative persons; 20.9 [95% CI, 13.8-28.0] per 10 000 antibody- and nucleic acid-negative persons). Residual risk for HBV infection was highest among injecting drug users (98.6 [95% CI, 36.4-213] per 10 000 antibody-negative people; 49.4 [95% CI, 18.2-107] per 10 000 persons who were also nucleic acid-negative).

CONCLUSIONS

Absolute risks of window period viral infections are low in people from Australian groups at increased risk but with negative viral test results. Accepting organ donations by people at increased risk of infection but with negative viral test results could be considered as a strategy for expanding the donor pool.

REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO), CRD42017069820.

摘要

目的

估计澳大利亚感染风险增加人群中人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）的流行率和发病率；估计这些人群中潜在实体器官供者在抗体和核酸检测结果均为阴性时的感染残余风险。

研究设计

对澳大利亚感染风险增加人群中 HIV、HCV 和 HBV 发生率和流行率的报告进行系统回顾和荟萃分析。

数据来源

MEDLINE、政府和机构报告、澳大利亚性健康学会、艾滋病毒、病毒性肝炎和性健康医学会议摘要、澳大利亚和新西兰临床试验注册中心以及 2000 年 1 月 1 日至 2019 年 2 月 14 日期间发表的澳大利亚国家卫生与医学研究理事会赠款；个人交流。

数据综合

男男性行为者的 HIV 感染残余风险最高（4.8 [95% CI，2.7-6.9]每 10 000 名抗体阴性者；1.5 [95% CI，0.9-2.2]每 10 000 名抗体和核酸均为阴性者）。注射吸毒者的 HCV 感染残余风险最高（289 [95% CI，191-385]每 10 000 名抗体阴性者；20.9 [95% CI，13.8-28.0]每 10 000 名抗体和核酸均为阴性者）。注射吸毒者的 HBV 感染残余风险最高（98.6 [95% CI，36.4-213]每 10 000 名抗体阴性者；49.4 [95% CI，18.2-107]每 10 000 名核酸亦为阴性者）。