在纽约市接受阿片类药物使用障碍药物辅助治疗的队列中丙型肝炎病毒的发病率。
Hepatitis C Virus Incidence in a Cohort in Medication-Assisted Treatment for Opioid Use Disorder in New York City.
机构信息
Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.
Center for Drug Use and HIV Research, New York, New York, USA.
出版信息
J Infect Dis. 2020 Sep 2;222(Suppl 5):S322-S334. doi: 10.1093/infdis/jiz659.
BACKGROUND
Hepatitis C virus (HCV) incidence has increased in the worsening opioid epidemic. We examined the HCV preventive efficacy of medication-assisted treatment (MAT), and geographic variation in HCV community viral load (CVL) and its association with HCV incidence.
METHODS
HCV incidence was directly measured in an open cohort of patients in a MAT program in New York City between 1 January 2013 and 31 December 2016. Area-level HCV CVL was calculated. Associations of individual-level factors, and of HCV CVL, with HCV incidence were examined in separate analyses.
RESULTS
Among 8352 patients, HCV prevalence was 48.7%. Among 2535 patients seronegative at first antibody test, HCV incidence was 2.25/100 person-years of observation (PYO). Incidence was 6.70/100 PYO among those reporting main drug use by injection. Female gender, drug injection, and lower MAT retention were significantly associated with higher incidence rate ratios. Female gender, drug injection, and methadone doses <60 mg were independently associated with shorter time to HCV seroconversion. HCV CVLs varied significantly by geographic area.
CONCLUSIONS
HCV incidence was higher among those with lower MAT retention and was lower among those receiving higher methadone doses, suggesting the need to ensure high MAT retention, adequate doses, and increased HCV prevention and treatment engagement. HCV CVLs vary geographically and merit further study as predictors of HCV incidence.
背景
丙型肝炎病毒（HCV）的发病率在不断恶化的阿片类药物流行中有所上升。我们研究了药物辅助治疗（MAT）对 HCV 的预防效果，以及 HCV 社区病毒载量（CVL）的地理差异及其与 HCV 发病率的关系。
方法
2013 年 1 月 1 日至 2016 年 12 月 31 日，在纽约市的 MAT 项目中，我们对一项开放队列中的患者进行了 HCV 发病率的直接测量。计算了区域 HCV CVL。分别在单独的分析中，研究了个体因素和 HCV CVL 与 HCV 发病率的相关性。
结果
在 8352 名患者中，HCV 患病率为 48.7%。在首次抗体检测呈阴性的 2535 名患者中，HCV 发病率为 2.25/100 人年观察（PYO）。报告主要药物注射使用的患者发病率为 6.70/100 PYO。女性、药物注射和 MAT 保留率较低与较高的发病率呈正相关。女性、药物注射和低于 60mg 的美沙酮剂量与 HCV 血清转换时间较短显著相关。HCV CVL 按地理区域差异显著。
结论
MAT 保留率较低的患者 HCV 发病率较高，而接受较高美沙酮剂量的患者 HCV 发病率较低，这表明需要确保 MAT 保留率高、剂量充足，并增加 HCV 的预防和治疗参与度。HCV CVL 在地理上存在差异，需要进一步研究，作为 HCV 发病率的预测因素。
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