中东和北非地区静脉注射吸毒人群中丙型肝炎病毒感染状况。
The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa.
机构信息
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
出版信息
Addiction. 2020 Jul;115(7):1244-1262. doi: 10.1111/add.14944. Epub 2020 Feb 3.
BACKGROUND AND AIMS
People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA).
METHODS
Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989-2018. Random-effects meta-analyses and meta-regressions were performed. Meta-regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity.
RESULTS
Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4-54.1%]. The country-specific pooled mean ranged from 21.7% (95% CI = 4.9-38.6%) in Tunisia to 94.2% (95% CI = 90.8-96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCV antibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%).
CONCLUSION
Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment.
背景与目的
静脉注射吸毒者（PWID）是感染丙型肝炎病毒（HCV）的高危人群。本研究旨在描绘中东和北非（MENA）地区 PWID 中的 HCV 流行病学情况。
方法
对 1989 年至 2018 年中东和北非 HCV 流行病学综合项目的标准化和系统收集数据库进行综合数据合成。采用随机效应荟萃分析和荟萃回归分析。荟萃回归变量包括国家、研究地点、数据收集年份和发表年份（评估 HCV 抗体流行率随时间的趋势）、样本量和抽样方法。估计了整个 MENA 地区慢性感染 PWID 的人数。计算香农多样性指数以评估基因型多样性。
结果
基于 118 项 HCV 抗体流行率指标，MENA 地区 PWID 的总体平均流行率为 49.3%（95%置信区间[CI]为 44.4%-54.1%）。具体国家的平均流行率范围从突尼斯的 21.7%（95% CI 为 4.9%-38.6%）到利比亚的 94.2%（95% CI 为 90.8%-96.7%）。估计有 221704 名 PWID 慢性感染，其中伊朗有 68526 人，巴基斯坦有 46554 人。没有统计学证据表明 HCV 抗体流行率随时间下降。基因型多样性中等（香农多样性指数为 1.95 中的 1.01；52.1%）。每种 HCV 基因型的平均百分比最高的是基因型 3（42.7%）和基因型 1（35.9%）。
结论
中东和北非地区有一半的静脉注射吸毒者似乎曾经感染过丙型肝炎病毒，但各国之间的抗体流行率存在很大差异。除了 20 多万名慢性感染的当前静脉注射吸毒者外，还有许多以前曾经注射过毒品但现在不再注射毒品的人，他们可能在过去的吸毒期间感染了丙型肝炎病毒。必须扩大减少伤害服务，并采用创新战略，确保获得丙型肝炎病毒检测和治疗的机会。
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