China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Sex Transm Infect. 2020 Dec;96(8):608-614. doi: 10.1136/sextrans-2019-054360. Epub 2020 Mar 18.
The rapid expansion of the recreational drug market becomes a global health concern. It is worrying that the bacterial and viral infection epidemics linking to drug use may worsen accordingly. This study aimed to estimate the impacts of changing trend and behaviours of using heroin only, synthetic drug (SD) only and polydrug (using SD and heroin concurrently) on HIV, hepatitis C virus (HCV) and syphilis epidemics among people who use drugs in China by 2035.
We constructed a compartmental model to estimate HIV, HCV and syphilis epidemics in the dynamic drug-use trend by three scenarios: SD-only use, heroin-only use and polydrug use based on Monte Carlo simulations. The parameters for the model were collected from a comprehensive literature search.
Our model estimated that polydrug use led to the highest HIV and HCV prevalence among three drug-use patterns. The prevalences were projected to increase from 10.9% (95% CI 10.2% to 11.5%) and 61.7% (95% CI 59.4% to 62.5%) in 2005 to 19.0% (95% CI 17.3% to 20.7%) and 69.1% (95% CI 67.3% to 69.5%), respectively, in 2035 among people using polydrug. Similarly, HIV and HCV prevalence in the SD-only group were projected to increase from 0.4% (95% CI 0.3% to 0.4%) and 19.5% (95% CI 19.4% to 21.7%) to 1.8% (95% CI 1.4 to 2.1%) and 33.7% (95% CI 33.2% to 34.9%) in 2005-2035. Conversely, HIV prevalence in the heroin-only group was projected to decrease from 8.0% (95% CI 7.6% to 8.1%) to 2.2% (95% CI 2.0% to 2.3%) in 2005-2035. Syphilis prevalence was estimated to remain unchanged in all population groups within this time frame. It was projected that the proportion of HIV transmitted by sexual transmission will increase compared with unsafe injection transmission in all people who use drugs from 2005 to 2035.
Our modelling suggests that polydrug use is projected to lead to the highest HIV and HCV disease burden by 2035, and the proportion of HIV transmitted by sexual transmission will increase. Current HIV intervention among people using heroin seems effective according to our estimation.
娱乐性毒品市场的迅速扩张成为全球关注的健康问题。令人担忧的是，与吸毒有关的细菌和病毒感染疫情可能会随之恶化。本研究旨在评估仅使用海洛因、合成药物（SD）和多药（同时使用 SD 和海洛因）的吸毒者的吸毒行为变化趋势对中国吸毒者中 HIV、丙型肝炎病毒（HCV）和梅毒流行的影响，到 2035 年。
我们构建了一个隔室模型，通过 Monte Carlo 模拟，根据三种情景估计 SD 仅使用、海洛因仅使用和多药使用情况下的 HIV、HCV 和梅毒流行情况。模型的参数是从全面的文献检索中收集的。
我们的模型估计，多药使用导致三种吸毒模式中 HIV 和 HCV 的患病率最高。预计患病率将从 2005 年的 10.9%（95%CI 10.2%至 11.5%）和 61.7%（95%CI 59.4%至 62.5%）上升至 2035 年的 19.0%（95%CI 17.3%至 20.7%）和 69.1%（95%CI 67.3%至 69.5%），分别为 2035 年使用多药者中的 69.1%（95%CI 67.3%至 69.5%）。同样，SD 组中 HIV 和 HCV 的患病率预计将从 0.4%（95%CI 0.3%至 0.4%）和 19.5%（95%CI 19.4%至 21.7%）上升至 1.8%（95%CI 1.4%至 2.1%）和 33.7%（95%CI 33.2%至 34.9%），2005 年至 2035 年。相比之下，海洛因组中 HIV 的患病率预计将从 2005 年的 8.0%（95%CI 7.6%至 8.1%）下降至 2035 年的 2.2%（95%CI 2.0%至 2.3%）。在这段时间内，所有人群的梅毒患病率预计都将保持不变。预计 2005 年至 2035 年期间，所有吸毒者中经性传播的 HIV 比例将高于经不安全注射传播的 HIV 比例。
我们的模型表明，到 2035 年，多药使用预计将导致 HIV 和 HCV 疾病负担最高，经性传播的 HIV 比例将增加。根据我们的估计，目前针对海洛因使用者的 HIV 干预措施似乎是有效的。
