Minoyan Nanor, Artenie Andreea A, Zang Geng, Jutras-Aswad Didier, Turcotte Marie-Ève, Bruneau Julie
Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
Am J Prev Med. 2020 Jun;58(6):845-853. doi: 10.1016/j.amepre.2020.01.024.
Needle and syringe programs and opioid agonist therapy are essential for harm reduction among people who inject drugs. Few studies assess their combined potential in preventing hepatitis C virus infection. No studies have assessed whether they perform similarly among individuals at risk of primary and recurrent infection. This study aimed to estimate the rates of hepatitis C virus acquisition according to harm reduction coverage among hepatitis C virus-naive and previously infected people who inject drugs in Montreal, Canada.
This prospective cohort study involved regular interviews and hepatitis C antibody and RNA testing (data collection: 2010-2017, analysis: 2018). Opioid agonist therapy coverage was defined by current dose: high (≥60 mg/day methadone, ≥16 mg buprenorphine), low, or none. Complete needle and syringe program coverage was defined as exclusively reporting safe needle and syringe sources (past 6 or 3 months). Combined coverage was defined as full (high-dose agonist/complete needle/syringe coverage), minimal (low-dose agonist/incomplete needle/syringe coverage), and partial (remaining combinations). Cox regression models were fit.
A total of 106 events were observed over 1,183.1 person-years for primary and recurrent incidence rates of 10.6 (95% CI=8.0, 13.8) and 7.6 (95% CI=5.6, 9.9) per 100 years, respectively. High-dose opioid agonist therapy was associated with a 77% reduction in hepatitis C virus acquisition (hazard ratio=0.23, 95% CI=0.10, 0.50) compared with not receiving opioid agonist therapy. Needle and syringe coverage was not associated with infection rates. Estimates considering their combination reflected opioid agonist therapy coverage. Associations were similar among hepatitis C virus-naive and previously infected people who inject drugs.
High-dose opioid agonist therapy seems particularly important to reduce drug-related harms among hepatitis C virus-naive and previously infected people who inject drugs in Montreal.
针具交换项目和阿片类激动剂疗法对于减少注射吸毒者的伤害至关重要。很少有研究评估它们在预防丙型肝炎病毒感染方面的联合潜力。尚无研究评估它们在初次感染和复发感染风险人群中的表现是否相似。本研究旨在根据加拿大蒙特利尔注射吸毒的丙型肝炎病毒未感染者和既往感染者的伤害减少覆盖情况，估计丙型肝炎病毒感染率。
这项前瞻性队列研究包括定期访谈以及丙型肝炎抗体和RNA检测（数据收集：2010 - 2017年，分析：2018年）。阿片类激动剂疗法覆盖情况根据当前剂量定义为：高剂量（美沙酮≥60毫克/天，丁丙诺啡≥16毫克）、低剂量或无。完整的针具交换项目覆盖定义为仅报告安全的针具来源（过去6个月或3个月）。联合覆盖定义为完全覆盖（高剂量激动剂/完整针具/注射器覆盖）、最小覆盖（低剂量激动剂/不完整针具/注射器覆盖）和部分覆盖（其余组合）。采用Cox回归模型。
在1183.1人年中总共观察到106起事件，初次感染和复发感染率分别为每100人年10.6（95%置信区间=8.0，13.8）和7.6（95%置信区间=5.6，9.9）。与未接受阿片类激动剂疗法相比，高剂量阿片类激动剂疗法使丙型肝炎病毒感染风险降低77%（风险比=0.23，95%置信区间=0.10，0.50）。针具和注射器覆盖与感染率无关。考虑它们联合情况的估计反映了阿片类激动剂疗法覆盖情况。在丙型肝炎病毒未感染者和既往感染者中，关联情况相似。
高剂量阿片类激动剂疗法对于减少加拿大蒙特利尔丙型肝炎病毒未感染和既往感染的注射吸毒者的药物相关伤害似乎尤为重要。
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