Chen Jane S, Levintow Sara N, Tran Ha V, Sibley Adams L, Blackburn Natalie A, Sripaipan Teerada, Hutton Heidi E, Go Vivian F, Chander Geetanjali
Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLOS Glob Public Health. 2024 Dec 5;4(12):e0003744. doi: 10.1371/journal.pgph.0003744. eCollection 2024.
The confluence of injection drug use (IDU), alcohol consumption, and viral hepatitis increases morbidity among persons living with HIV (PWH). We present a secondary analysis of a randomized controlled trial of alcohol reduction interventions in Thai Nguyen, Vietnam conducted between 2016-2018. We assessed hepatitis B (HBV) and hepatitis C (HCV) coinfection among PWH reporting hazardous alcohol consumption and examined differences in IDU and alcohol use by coinfection status. Participants were ≥18 years old, living with HIV, and reported hazardous alcohol consumption per the WHO Alcohol Use Disorders Identification Test Consumption (AUDIT-C; score ≥4 for men, score ≥3 for women). At enrollment, participants were tested for hepatitis coinfection with HBV surface antigen tests and rapid serological HCV tests. Demographic information, IDU, and recent alcohol consumption were assessed via behavioral survey and 30-day timeline follow back. Fishers Exact and Kruskal-Wallis tests were used for statistical testing. Hepatitis coinfection was common among the 440 enrolled PWH: HCV: n = 355 (81%); HBV: n = 5 (1%); HBV and HCV: n = 37 (8%). Only 10% (n = 43) of participants had no hepatitis coinfection. Among those who tested positive for HBV, 36% had previously been diagnosed with HBV; among those who tested seropositive for HCV, 18% had previously received an HCV diagnosis. History of IDU was higher among those with hepatitis coinfection (HBV or HCV coinfection: 88%; HBV and HCV coinfections: 97%) than those without hepatitis coinfection (7%; p<0.01). Median days of alcohol consumption in the last 30 days was higher among those with coinfection (HBV or HCV coinfection: 20 (Interquartile Range (IQR): 10-30); HBV and HCV coinfections: 22 (IQR: 13-28) than those without hepatitis coinfection (10; IQR: 6-21; p<0.01). The syndemic conditions of HIV, hepatitis, IDU, and alcohol use are deeply entangled and challenging to parse out. Integrated health services are warranted to reduce the risk of liver-related morbidity.
注射吸毒、饮酒与病毒性肝炎并存，增加了艾滋病毒感染者（PWH）的发病率。我们对2016年至2018年在越南谅山进行的一项酒精减少干预随机对照试验进行了二次分析。我们评估了报告有危险饮酒行为的艾滋病毒感染者中的乙型肝炎（HBV）和丙型肝炎（HCV）合并感染情况，并按合并感染状态检查了注射吸毒和饮酒情况的差异。参与者年龄≥18岁，感染艾滋病毒，且根据世界卫生组织酒精使用障碍识别测试消费版（AUDIT-C；男性得分≥4，女性得分≥3）报告有危险饮酒行为。入组时，通过HBV表面抗原检测和快速血清学HCV检测对参与者进行肝炎合并感染检测。通过行为调查和30天时间线回顾评估人口统计学信息、注射吸毒情况和近期饮酒情况。采用Fisher精确检验和Kruskal-Wallis检验进行统计分析。在440名入组的艾滋病毒感染者中，肝炎合并感染很常见：HCV：n = 355（81%）；HBV：n = 5（1%）；HBV和HCV：n = 37（8%）。只有10%（n = 43）的参与者没有肝炎合并感染。在HBV检测呈阳性的参与者中，36%以前被诊断为HBV；在HCV血清学检测呈阳性的参与者中，18%以前接受过HCV诊断。肝炎合并感染患者（HBV或HCV合并感染：88%；HBV和HCV合并感染：97%）的注射吸毒史高于无肝炎合并感染患者（7%；p<0.01）。合并感染患者（HBV或HCV合并感染：20天（四分位间距（IQR）：10 - 30）；HBV和HCV合并感染：22天（IQR：13 - 28））在过去30天的饮酒天数中位数高于无肝炎合并感染患者（10天；IQR：6 - 21；p<0.01）。艾滋病毒、肝炎、注射吸毒和饮酒的综合征状况相互交织，难以厘清。有必要提供综合卫生服务以降低肝脏相关疾病的风险。
