荷兰阿姆斯特丹的针具交换项目和阿片类激动剂治疗对注射吸毒者感染艾滋病毒、乙型肝炎和丙型肝炎病毒风险的影响：一项模拟目标试验的结果。
The effect of needle and syringe program and opioid agonist therapy on the risk of HIV, hepatitis B and C virus infection for people who inject drugs in Amsterdam, the Netherlands: findings from an emulated target trial.
机构信息
Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.
出版信息
Addiction. 2021 Nov;116(11):3115-3126. doi: 10.1111/add.15503. Epub 2021 May 3.
BACKGROUND AND AIMS
Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm-reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands.
DESIGN
We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985-2014).
SETTING
Amsterdam, the Netherlands.
PARTICIPANTS
We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively.
INTERVENTIONS
Intervention arms were: complete HRP participation [≥ 60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use] versus no HRP and partial HRP participation combined (< 60 methadone mg/day and/or < 100% NSP coverage).
CONCLUSIONS
Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands.
MEASUREMENTS
Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models.
FINDINGS
Compared with no/partial HRP participation, complete HRP participation led to lower risk of HIV [HR = 0.54, 95% confidence interval (CI) = 0.27-1.08], HCV (HR = 0.16, 95% CI = 0.06-0.40) and HBV (HR = 0.28, 95% CI = 0.13-0.61) acquisition.
背景和目的
在荷兰，由于早期实施了减少伤害计划（HRP），注射吸毒者（PWID）中的艾滋病毒和丙型肝炎病毒（HCV/HBV）的发病率大幅下降，但随着时间的推移，选择性死亡率以及人口和毒品市场的变化等其他因素可能也促成了观察到的发病率下降。我们量化并测试了 HRP 参与对阿姆斯特丹 PWID 感染这些疾病的风险的影响。
设计
我们使用阿姆斯特丹队列研究（1985-2014 年）的观察数据模拟了一个假设的理想随机试验的设计。
地点
荷兰阿姆斯特丹。
参与者
我们纳入了曾使用过阿片类药物、最近有过注射吸毒史且 HIV、HCV 或 HBV 检测均为阴性的 PWID。在 983 名参与者中，640、137 和 308 名参与者分别纳入 HIV、HCV 和 HBV 分析，分别观察到 59、45 和 49 例血清转换。
干预措施
干预组为：完全 HRP 参与（≥60mg/天美沙酮和 100%针具交换计划（NSP）覆盖，或无近期注射吸毒史时任何美沙酮剂量）与无 HRP 和部分 HRP 参与（<60mg/天美沙酮和/或<100%NSP 覆盖）。
结论
在荷兰，完全参与减少伤害计划似乎导致了注射吸毒者中 HIV 和丙型肝炎和乙型肝炎病毒（HBV）感染风险的大幅降低。
测量
对于每种感染，我们使用边缘结构模型估计了 HRP 臂之间的风险比（HR）。
发现
与无/部分 HRP 参与相比，完全 HRP 参与导致 HIV [HR=0.54，95%置信区间（CI）=0.27-1.08]、HCV（HR=0.16，95%CI=0.06-0.40）和 HBV（HR=0.28，95%CI=0.13-0.61）感染的风险降低。
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