Hospital Universitario Infanta Leonor, Madrid, Spain.
Universidad Complutense de Madrid (UCM), Madrid, Spain.
Infect Dis Poverty. 2021 Aug 19;10(1):111. doi: 10.1186/s40249-021-00894-5.
The burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant. We aimed to screen HIV infection among PWUD and describe their retention in HIV care. Besides, we also screen for hepatitis C virus (HCV) infection among HIV-seropositive PWUD and describe their linkage to care.
We conducted a prospective study in 529 PWUD who visited the "Cañada Real Galiana" (Madrid, Spain). The study period was from June 1, 2017, to May 31, 2018. HIV diagnosis was performed with a rapid antibody screening test at the point-of-care (POC) and HCV diagnosis with immunoassay and PCR tests on dried blood spot (DBS) in a central laboratory. Positive PWUD were referred to the hospital. We used the Chi-square or Fisher's exact tests, as appropriate, to compare rates between groups.
Thirty-five (6.6%) participants were positive HIV antibodies, but 34 reported previous HIV diagnoses, and 27 (76%) had prior antiretroviral therapy. Among patients with a positive HIV antibody test, we also found a higher prevalence of homeless (P < 0.001) and injection drug use (PWID) (P < 0.001), and more decades of drug use (P = 0.002). All participants received HIV test results at the POC. Of the 35 HIV positives, 28 (80%) were retained in HIV medical care at the end of the HIV screening study (2018), and only 22 (62.9%) at the end of 2020. Moreover, 12/35 (34.3%) were positive for the HCV RNA test. Of the latter, 10/12 (83.3%) were contacted to deliver the HCV results test (delivery time of 19 days), 5/12 (41.7%) had an appointment and were attended at the hospital and started HCV therapy, and only 4/12 (33.3%) cleared HCV.
We found almost no new HIV-infected PWUD, but their cascade of HIV care was low and remains a challenge in this population at risk. The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.
人类免疫缺陷病毒（HIV）感染在吸毒者（PWUD）中的负担很大。我们旨在筛查吸毒者中的 HIV 感染情况，并描述他们在 HIV 护理中的保留情况。此外，我们还筛查了 HIV 血清阳性的吸毒者中的丙型肝炎病毒（HCV）感染情况，并描述了他们与护理的联系。
我们在 529 名前往西班牙马德里“Cañada Real Galiana”的吸毒者中进行了一项前瞻性研究。研究期间为 2017 年 6 月 1 日至 2018 年 5 月 31 日。HIV 诊断采用现场即时抗体筛查试验（POC）进行，HCV 诊断采用免疫分析法和中央实验室的干血斑（DBS）聚合酶链反应（PCR）试验进行。阳性吸毒者被转介到医院。我们使用卡方检验或 Fisher 确切概率法，根据需要比较组间差异。
35 名（6.6%）参与者 HIV 抗体阳性，但 34 名报告了既往 HIV 诊断，27 名（76%）接受了抗逆转录病毒治疗。在 HIV 抗体检测阳性的患者中，我们还发现无家可归者（P<0.001）和注射吸毒者（PWID）（P<0.001）的患病率更高，且吸毒年限更长（P=0.002）。所有参与者均在 POC 获得 HIV 检测结果。在 35 例 HIV 阳性患者中，28 例（80%）在 HIV 筛查研究结束时（2018 年）仍保留在 HIV 医疗护理中，而在 2020 年底时仅 22 例（62.9%）。此外，35 例中有 12 例 HCV RNA 检测呈阳性。在这 12 例中，10 例（83.3%）被联系告知 HCV 检测结果（通知时间为 19 天），5 例（41.7%）在医院预约并接受了治疗，只有 4 例（33.3%）清除了 HCV。
我们发现几乎没有新的 HIV 感染吸毒者，但他们的 HIV 护理级联反应很低，这仍然是该高危人群面临的挑战。HIV 感染的吸毒者中丙型肝炎的高频率反映了 HCV 筛查的必要性，并加强了与护理的联系。
