佛山市吸毒人群艾滋病、乙型肝炎、丙型肝炎及梅毒感染状况调查

目的 了解佛山市吸毒人群HIV、肝炎和梅毒的感染情况,为预防、控制和治疗提供参考依据。方法 对佛山市2003年部分在押吸毒人员进行HIV、HBV、HCV和梅毒血清学检测。结果 706名吸毒者血液标本中,抗-HIV、HBsAg、抗-HCV及梅毒抗体阳性率分别为3．5％、21．1％、60．1％和5．9％。在检出的25例HIV感染者中,HIV／HBV、HIV／HCV、HIV／TP双重感染率分别为32．0％(8／25)、40．0％(10／25)和4．0％(1／25),HIV／HBV／HCV三重感染率为28．0％(7／25),未发现四重感染的现象。结论 应加大对吸毒人群的监测和防病知识宣传力度,开展干预措施,降低HIV等疾病在高危人群中扩散和传播的危险性。     

Prevalence and determinants of hepatitis C virus infection among female drug injecting sex workers in Glasgow

Background  

Few studies of the prevalence of hepatitis C virus (HCV) infection have focussed on women who work as street sex workers to finance their drug use.     

Coinfections by HIV, hepatitis B and hepatitis C in imprisoned injecting drug users

In order to know the prevalence and risk factors for coinfections by human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among injecting drug users (IDUs), a cross-sectional study was carried out in two prisons of the province of Cantabria, northern Spain. Three hundred and sixty-two IDU inmates were recruited. All inmates were interviewed and their blood tested for HIV, HBV and HCV. Crude and multiple risk factor adjusted for (by polychotomous logistic regression) odds ratios were calculated. Prevalence of HBV-HCV coinfection (42.5%) was higher than HIV-HBV-HCV coinfection (37.3%), whereas monoinfections were very uncommon (overall: 13%). Long-term injectors and reincarceration were the foremost risk factors for both coinfections, showing a trend between the degree of association and the number of viruses infecting a patient. No significant relationship between coinfection status and sexual practices was observed. The results related to coinfections are consistent with previous studies of prevalence and risk factors for HIV, HBV and HCV, in indicating that the high rates of coinfections among IDU inmates emphasise the need to harm-reduction policy across prisons in Spain.     

Case-reporting of acute hepatitis B and C among injection drug users

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute bepatitis B and C reported to the bealth department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both bad acute bepatitis B. The upper 95% confidence limit for case-reporting of bepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute bepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.     

吸毒方式与艾滋病、梅毒和丙型肝炎感染关系

目的分析吸毒人群艾滋病、梅毒和丙肝的感染情况,为制定艾滋病控制措施提供科学依据。方法用SPSS 12.0统计软件分析793名被调查者的流行病学调查资料。结果吸毒者男性多于女性,年龄以20~40岁为主,多来自于外省。静脉和肌肉注射多于口吸;文化程度以中学为主。梅毒与吸毒无明显联系(P>0.05),注射吸毒与艾滋病、丙型肝炎有明显联系(P<0.05);共针率占注射吸毒人数的22.3%。结论预防共针对吸毒感染艾滋病及丙型肝炎工作任重而道远,禁毒、戒毒与提倡安全注射应打防并举。     

Follow-up for medical care among drug users with hepatitis C

Prevalence of hepatitis C (HCV) in injection drug users (IDUs) is high and once HCV has been detected, follow-up medical care is essential. Six hundred and one current and former IDUs who tested positive for HCV antibodies received referrals for medical care. Twenty-four percent (147) of participants returned to be interviewed regarding their medical follow-ups. Of these, only 42% (61) had sought additional medical care in the form of further liver or blood tests or liver ultrasound. Four variables predicted seeking medical care: (a) ever being in residential drug treatment, (b) ever trading sex for money, (c) self-reported homelessness, and (d) living in one's own apartment or house. Having income from a job was inversely associated with seeking medical care. Knowledge of HCV infection alone does not mean that IDUs will seek medical care. Additional education concerning medical care and treatment options are needed to address IDU needs.     

The hepatitis C virus epidemic among injecting drug users.

Given the economic and health costs of hepatitis C virus (HCV) infection, and the ongoing transmission within the injecting drug user (IDU) population, there is a need for improved understanding of HCV epidemiology within this risk group. We employed a recently developed method based on phylogenetic analysis to infer HCV epidemic history and to provide the first estimates of the rate of spread of subtypes 1a and 3a circulating within injecting drug user populations. The data indicates that HCV subtype 1a entered the IDU population on at least three separate occasions. Both subtypes demonstrate exponential population growth during the 20th century, with a doubling time of 7-8 years. The results provide a baseline for prediction of the future course of the HCV epidemic, and its likely response to transmission control policies.     

吸毒人群中丙型肝炎患者F蛋白抗体检测

目的了解丙型肝炎病毒（HCV）F抗体在南京市吸毒人群HCV感染者中的分布特点,为丙型肝炎防治及制定慢性化预防策略提供依据。方法利用pEGX-4T-2/HCV-F融合载体表达蛋白HCV-F/GST作为抗原,包被酶联反应板,ELISA间接法检测362例HCV感染者及50例正常人血清HCV-F抗体,结合其人口学特征和疾病特征,统计分析HCV-F抗体的分布情况及与HCV感染的关系。结果 362例感染HCV的吸毒者F抗体阳性率为31.5%。通过比较发现F抗体阳性率在性别、吸毒时间、吸毒方式等因素中分布无统计学差异,而F抗体阳性率与年龄、联合感染可能具有一定关联。结论南京市吸毒人群HCV感染者中存在F抗体,其可能与疾病病程相关。     

Seroprevalence of viral hepatitis A, B and C in intravenous drug users

Markers of viral hepatitis A-C of 99 intravenous drug users predominantly (in 96%) from the Karviná district were examined from March 1998 to February 1999. Pervitin (methamphetamine) was the basic drug in all subjects. Anti-HAV was detected in 6.4% of VHA non-vaccinated individuals, anti-HAV/IgM was not found in any case, HBsAg was detected in 4.0% (acute VHB was diagnosed in all these cases), anti-HBc in 9.2% and anti-HCV in 25.0% of the investigated cases. Our results confirmed the importance of drug use by injection, esp. needle sharing, for the spread VHB and VHC. In case of VHA the fecal-oral route of transmission in this subpopulation is dominant.     

我国吸毒人群中艾滋病病毒与丙型肝炎病毒的感染状况

相对其他人群,我国吸毒人群具有较高的艾滋病病毒与丙型肝炎病毒的感染率以及合并感染率,是影响该人群健康的主要问题之一。本文从地区分布、人群分布方面描述和比较了艾滋病病毒与丙型肝炎病毒在我国吸毒人群面的染GZ中的感染以及合并感染的情况,分析了两种病毒通过相互影响,在病毒传播与致病方面产生的危害,并对相应的防治工作提出了建议。     

Prevalence of hepatitis C in a drug using and non-using welfare population

CONTEXT: Drug use is a primary route for the transmission of the Hepatitis C virus (HCV). A substantial proportion of welfare recipients have been shown to be substance abusers. In addition, federal legislation has imposed limits on the number of months individuals may receive benefits and has mandated most recipients to participate in a 'work activity' in exchange for benefits. HCV symptoms may inhibit welfare recipients' ability to seek and maintain employment. OBJECTIVE: To assess the prevalence of HCV in a sample of Temporary Assistance to Needy Families (TANF) recipients and the effects of HCV antibody seropositivity on employability. DESIGN, SETTING, AND PARTICIPANTS: The sample for this study consisted of 380 individuals participating in a longitudinal study of employment patterns among TANF recipients in Houston, TX, funded by the National Institute on Drug Abuse (NIDA). Private interviews regarding welfare receipt, employment, and drug use were conducted at intake into the study and at 4-month intervals for one year. Participants agreed to a one-time blood test. Blood samples were tested for the presence of HCV antibodies by enzyme linked immunoassay. MAIN OUTCOME MEASURE: Employment status over time by HCV antibody status. RESULTS: Overall, 12% of all participants tested positive for the presence of HCV antibodies. A significantly greater proportion of chronic drug users (31%) than non-drug users (4%) tested positive for the presence of Hepatitis C antibodies. Those who tested positive for hepatitis C had significantly lower rates of employment. CONCLUSIONS: Potential infection with Hepatitis C may constitute an employment barrier for many welfare recipients.     

Factors associated with prevalent hepatitis C: differences among young adult injection drug users in lower and upper Manhattan, New York City

OBJECTIVES: This study examined correlates of prevalent hepatitis C virus (HCV) infection among young adult injection drug users in 2 neighborhoods in New York City. METHODS: Injection drug users aged 18 to 29 years were street recruited from the Lower East Side and Harlem. Participants were interviewed about drug use and sex practices; venipuncture was performed for hepatitis B virus (HBV), HCV, and HIV serologies. RESULTS: In both sites, testing positive for HCV antibody (anti-HCV) was associated with having injected for more than 3 years. Additionally, HCV infection was positively associated with injecting with someone known to have had hepatitis (but the association was significant only in the Lower East Side) and with sharing cotton (but the association was statistically significant only in Harlem). Being in drug treatment and older than 24 years were associated with HCV in the Lower East Side but not in Harlem. Receiving money for sex was associated with anti-HCV positivity in Harlem but not in the Lower East Side. CONCLUSIONS: Several differences in factors associated with prevalent HCV infection existed among 2 populations of young injection drug users from the same city. Indirect transmission of HCV may occur.     

Epidemiology of hepatitis C virus infection among injecting drug users in Australia.

STUDY OBJECTIVE: To review the epidemiology of hepatitis C virus (HCV) infection among injecting drug users (IDUs) in Australia, and consider needs for further research and prevention policies and programmes. DESIGN: (1) Review of the results of surveillance for HCV; (2) review of published literature on prevalence, incidence, and risk factors for HCV among IDUs; and (3) reconstruction of incidence rates from prevalence studies of HCV in IDUs. SETTING AND PARTICIPANTS: Field and clinic based studies of IDUs in Australia. MAIN RESULTS: HCV has been present at high prevalences (of the order of 60-70%) in populations of Australian IDUs since at least 1971. Duration of injecting and main drug injected were the main predictors of seropositivity, the latter possibly a surrogate for frequency of injecting and both together as surrogate for cumulative numbers of times injected. Risk of infection begins with first injection and continues as long as injecting does. Current incidence is approximately 15 per 100 person years, and up to 40 per 100 person years in some subpopulations. Incidence may have decreased through the 1980s as a result of behaviour change in relation to HIV, as it has for hepatitis B, but not significantly so. CONCLUSIONS: Control of HCV infection in Australia will depend on effectiveness of measures to control HCV spread among IDUs. This will be a greater challenge than the control of HIV in this population has been. Needs identified include improved surveillance, especially for recently acquired infection, better understanding of exact transmission modes, and urgent improvement in prevention strategies.     

Cost-effectiveness of harm reduction in preventing hepatitis C among injection drug users.

OBJECTIVES: Hepatitis C (HCV) has emerged as a major epidemic among injection drug users (IDUs), with observed prevalence exceeding 70% in many American and European cities. This article explores the potential of syringe exchange programs (SEPs) to reduce HCV incidence and prevalence. DESIGN: A random-mixing epidemiological model is used to examine the potential impact of harm reduction interventions. METHODS: Steady-state analysis is used to scrutinize the impact of SEP on HCV incidence and prevalence and to examine the accuracy of short-term incidence analysis in predicting long-run program effects. RESULTS: SEP is predicted to have little impact on HCV incidence and prevalence within realistic populations of IDUs. CONCLUSIONS: Short-term incidence analysis substantially overstates SEP effectiveness and cost-effectiveness in preventing HCV. More comprehensive harm reduction models, coupled with referral of active IDUs to treatment, must complement syringe exchange to successfully contain highly infectious blood-borne diseases.     

Unstable housing and hepatitis C incidence among injection drug users in a Canadian setting

Background  

There has emerged growing recognition of the link between housing and health. Since Vancouver, Canada has had increasing concerns with homelessness brought about by urban renewal in the lead-up to the 2010 Winter Olympic Games, we evaluated hepatitis C virus (HCV) incidence among injection drug users (IDU) with and without stable housing.     

Irish injecting drug users and hepatitis C: the importance of the social context of injecting

BACKGROUND: The incidence of hepatitis C (HCV) infection among injecting drug users (IDUs) in Dublin is particularly high by international standards. The most robust predictor of an IDU's HCV status is his or her total number of lifetime injecting episodes. It has been proposed that participation in specific unsafe injecting practices is the principal contributor to this accumulated risk. We sought to test this hypothesis. The relationship between social context of injecting and HCV status was also examined. METHODS: We conducted a cross-sectional survey of IDUs recruited from treatment settings in Dublin. Participants had injected in the preceding six months and had not previously been tested for HCV. A structured interview was conducted. RESULTS: HCV testing was performed on 159 IDUs, and 61% were antibody positive. The three characteristics that were significant independent predictors of a positive test result were increased total number of lifetime injecting episodes, closer social relationships with other IDUs, and injecting in the home of other IDUs. Frequency of recipient syringe sharing (i.e. borrowing used syringes from other IDUs), backloading, and sharing of injecting paraphernalia were not independently associated with infection. CONCLUSIONS: We found that the robust association between HCV infection and number of lifetime injecting episodes was not explained by increased unsafe injecting practices. The socialized nature of heroin injecting in Dublin is contributing to the HCV epidemic in this population. Our findings suggest that accidental and unnoticed sharing of injecting equipment may be an important contributor to an IDU's increasing risk of infection over time.