四川省吸毒人群艾滋病病毒和梅毒新发感染的队列研究

目的调查四川省某地区静脉吸毒人群艾滋病病毒（HIV）和梅毒血清抗体阳转情况及其危险因素.方法2002年11月在四川省西昌市以社区为基础招募HIV血清抗体阴性的静脉吸毒人群前瞻性研究队列333人,在队列每6个月随访时调查静脉吸毒人群高危吸毒行为和性行为情况,并采集血样进行HIV和梅毒抗体检测.结果队列随访2年,静脉吸毒人群队列保持率和HIV血清抗体阳转率分别为75.7%和2.53/100人年（95%CI：1.10～3.97）,在多因素Poisson回归模型分析中,民族（RR=12.42,95%CI：2.72～56.74,P=0.0012）、近3个月共用针头或注射器（RR=4.06,95%CI：1.29～12.81,P=0.0168）与HIV血清抗体阳转的关系有统计学意义.该研究队列梅毒血清抗体阳转率为4.71/100人年（95%CI：2.59～6.82）,在多因素Poisson回归模型中,女性（RR=4.42,95%CI：1.78～10 99,P=0.0014）与梅毒血清抗体阳转的关系有统计学意义.结论该地区静脉吸毒人群HIV和梅毒新发感染率高,应采取有效的干预措施以控制HIV的传播流行.     

静脉吸毒共用注射器具方式和性行为与丙型肝炎病毒感染关系的研究

目的 了解四川省凉山州某地区静脉吸毒人群共用注射器具方式及性行为与丙型肝炎病毒(HCV)感染的关系。方法 以社区为基础使用标准化问卷调查静脉吸毒人群人口学特征和静脉吸毒共用注射器具方式、性行为情况;通过检测研究对象的HCV抗体确定是否感染HCV。结果 在静脉吸毒379人中,静脉吸毒人群HCV感染率为对71.0％(269/379)。单因素分析结果显示近3个月共用针头或注射器和既往感染梅毒在HCV感染方面差异有统计学意义。趋势性检验发现随着共用针头或注射器、共用洗针头或注射器水的频率以及共用注射器具伙伴数的增加HCV的感染率也在增加。多因素分析结果显示,近3个月共用针头或注射器。既往感染梅毒是HCV感染的危险因素,其OR值分别为1.468(95％CI:1.045～2.061)和2.914(95％CI:1.327～6.398)。未见性行为对HCV感染的影响。结论 需考虑采用定群血清流行病学研究来进一步阐明静脉吸毒共用注射器具方式及性行为同HCV感染的关系及其联系强度。     

吸毒人群队列本底的人口学和HIV 高危行为因素与保持率关系的研究

目的　了解静脉吸毒队列保持人群社会人口学和高危行为特征以及HIV血清阳转率。方法　于 2 0 0 2 - 11,在四川省凉山地区从社区招募了HIV抗体阴性的静脉吸毒人群前瞻性研究队列 333人。分析队列本底的静脉吸毒人群社会人口学和HIV高危行为特征与队列保持率的关系 ,以及在队列第 1次 6个月随访时进行HIV抗体检测来估算HIV血清阳转率。结果　静脉吸毒人群队列半年的HIV血清阳转率为 4 0 4× 10 - 2 /人年 (95 %CI:0 5 0～ 7 5 9)和保持率为 74 8% (2 4 9/333)。在单因素χ2 分析中 ,民族和文化程度分别与队列保持率的差异有统计学意义。在多因素Logistic回归分析中 ,民族与队列保持率的差异有统计学意义 ,其OR值为 0 4 8(95 %CI:0 2 9～ 0 80 )。结论　本研究队列静脉吸毒人群HIV血清阳转率高 ;彝族或其他少数民族静脉吸毒人群队列保持率低。     

静脉吸毒人群HIV阳转率与队列保持影响因素

目的了解静脉吸毒人群HIV血清抗体阳转率和队列本底的社会人口学和高危行为特征以及6个月随访情况与队列12个月保持率的关系。方法于2002年11月,在四川省西昌市从社区筛查HIV抗体阴性的静脉吸毒人群前瞻性研究队列333人。在队列每6个月随访时进行HIV抗体检测来估算HIV血清抗体阳转率和分析队列本底的社会人口学和高危行为特征以及6个月随访情况与队列12个月保持率的关系。结果静脉吸毒人群队列12个月的HIV血清抗体阳转率为3.17×10-2人年(95%CI=0.98~5.37)和保持率为70.3%。在多因素Logistic回归分析中,与队列12个月保持率差异有统计学意义的变量为6个月能随访到(OR=8.74,95%CI=4.95~15.41;P<0.0001)和彝族(OR=0.50,95%CI=0.28~0.87;P<0.0151)。未见静脉吸毒人群队列本底的HIV高危行为因素与队列12个月保持率的关系差异有统计学意义。结论静脉吸毒人群HIV血清抗体阳转率彝族和6个月未随访到的吸毒人群队列12个月的保持率低。     

四川省西昌市吸毒人群HCV感染及其危险因素研究

目的　了解四川省西昌市吸毒人群吸毒方式及性行为特征与HCV感染的关系。方法　于2 0 0 4 - 0 5 / 0 7,调查四川省西昌市吸毒人群的社会人口学、吸毒方式及性行为特征与HCV感染的关系。采集血样进行HCV和梅毒抗体检测。结果　在调查的吸毒人群6 19人中,HCV感染率为5 5 .9% (346 / 6 19) ,其中静脉吸毒者的HCV感染率为71 9% (2 35 / 32 7)。在单因素和多因素分析中,曾经静脉注射吸毒(OR =2 .6 3;95 %CI为1 .79～3 .89,P <0 .0 0 1)和曾经共用针头或注射器具吸毒(OR =2 .98,95 %CI为1 .78～5 . 0 0 ,P <0 . 0 0 1)与HCV感染有统计学意义。结论　吸毒人群HCV感染与其高危吸毒行为有关。     

共用注射器静脉吸毒与HIV感染关系的研究

目的探讨吸毒人群共用注射器静脉吸毒与HIV感染的关系。方法于2004-05/07,采用横断面研究调查四川省西昌市吸毒人群的社会人口学、吸毒频率、共用注射器静脉吸毒的次数和伙伴人数以及性行为特征。同时采集血样进行HIV和抗体检测。结果调查吸毒人群451人,HIV感染率为15.1%(68/451),其中静脉吸毒人群HIV感染率为17.8%(66/370)。在多因素Logistic回归模型分析中,与HIV感染关系有统计学意义的变量是彝族(OR=2.91;95%CI,1.67～5.10)、至今共用注射器具静脉吸毒的总次数(1～19次OR=4.67;95%CI,2.35～9.26;20次及以上OR=4.20;95%CI,1.52～11.61)和至今共用注射器具静脉吸毒的伙伴人数7人及其以上(OR=2.17;95%CI,1.01～4.68)。结论吸毒人群共用注射器具静脉吸毒的社会网络大小与其HIV感染有关,需通过降低共用注射器具静脉吸毒的次数和伙伴人数来控制HIV的传播流行。     

以社区为基础的静脉吸毒人群丙型肝炎病毒感染危险因素研究

目的　了解四川省凉山州地区静脉吸毒人群丙型肝炎病毒感染情况及其危险因素。方法　以社区为基础调查静脉吸毒人群丙型肝炎病毒感染危险因素 ,通过检测研究对象的丙型肝炎病毒抗体确定是否感染丙型肝炎病毒。结果　静脉吸毒人群丙型肝炎病毒感染率为 71.0 % (2 6 9/379)。在多因素 logistic回归模型分析中 (P<0 .0 5 ) ,共用注射器具次数的 OR值为 2 .0 5 3,其 95 %CI为 1.4 5 8～ 2 .891。在单因素χ2 分析中 (P <0 .0 5 ) ,共用注射器具次数、共用注射器具吸毒年限、近 3个月平均每天静脉吸毒频率等多个因素同丙型肝炎病毒感染有关。结论　需进一步研究阐明静脉吸毒共用注射器具方式对丙型肝炎病毒感染的影响     

社区静脉吸毒人群人类免疫缺陷病毒感染现状

目的　了解四川省凉山彝族自治州静脉吸毒人群人类免疫缺陷病毒 (HIV)感染率及其危险因素。方法　于 2 0 0 2年 11月 8～ 2 9日 ,以社区招募方式调查凉山彝族自治州地区静脉吸毒人群的社会人口学、静脉吸毒共用注射器具和性行为方式与HIV感染的关系。采集血样进行HIV和梅毒抗体检测。结果　提供知情同意和符合纳入标准的 379人 ,HIV感染率为 11 3% (43人 )。在单因素χ2 分析中 ,民族、近 3个月共用注射器具总次数、近 3个月共用棉球和梅毒感染与HIV感染有关。在多因素logistic回归模型分析中 ,近 3个月共用注射器具总次数 (OR =2 2 8;95 %CI为 1 18～ 4 4 3)和梅毒感染 (OR =3 10 ;95 %CI为 1 4 8～ 6 4 8)与HIV感染有关。结论　近 3个月共用注射器具总次数和梅毒感染与HIV感染有关。     

西昌市吸毒人群HIV感染模式研究

目的：了解四川省西昌市吸毒人群吸毒方式及性行为与HIV感染的关系.方法：采用现况调查对四川省西昌市吸毒人群的社会人口学、共用注射器具静脉吸毒方式、伙伴人数和性行为情况与HIV感染的关系进行调查.同时采集血样进行HIV和梅毒抗体检测.结果：吸毒人群619人中,HIV感染率为8.6%（53/619）,其中静脉吸毒者的HIV感染率为10.1%（33/327）.在单因素分析和控制其他因素分析中,至今共用注射器具静脉吸毒的伙伴总人数与HIV感染差异均有统计学意义.趋势性检验发现随着至今共用注射器具静脉吸毒的伙伴人数的增加,吸毒人群HIV感染率也在增加.在多因素Logistic回归模型分析中,发现与HIV感染差异有统计学意义的变量是共用注射器具静脉吸毒的伙伴总人数（1～3人OR=2.47,95%CI为1.21～5.04;≥4人OR=5.13,95%CI为2.30～11.46）和彝族（OR=3.71,95%CI为2.04～6.75）.结论：吸毒人群共用注射器具静脉吸毒的社会网络大小与HIV感染有关.     

直接和间接共用注射器具静脉吸毒方式与HIV感染关系的研究

目的了解四川省凉山彝族自治州地区吸毒人群直接和间接共用注射器具静脉吸毒方式与HIV感染的关系。方法于2004年5月至7月，从社区中招募吸毒人群调查其社会人口学特征、近3个月直接和间接共用注射器具静脉吸毒方式、近6个月性行为情况。采集研究对象的血样进行HIV抗体检测。结果在调查的吸毒人群中HIV感染率为15．1％（68／451），其中静脉吸毒人群HIV感染率为17．8％（66／370）。多因素Logistic分析结果显示，民族（OR为2．40；95％CI为1．39～4．13）、近3个月共用针头和注射器（OR为2．02；95％CI为1．12～3．63）、近3个月共用洗针头或注射器用水（OR，4．00；95％；CI，1．28～12．54）与HIV感染关系有统计学意义。结论四川省凉山彝族自治州吸毒人群HIV感染率高，直接和间接共用注射器具静脉吸毒行为以及高危性行为普遍，应加强对此类行为的干预。     

The multiperson use of non-syringe injection equipment and risk of hepatitis c infection in a cohort of young adult injection drug users, chicago 1997-1999

PURPOSE: The possibility that hepatitis C virus (HCV) is transmitted via the multiperson use of injection paraphernalia other than syringes has been suggested, but epidemiologic studies to examine the association are difficult to design due to saturation levels of infection in most samples of injection drug users (IDUs). This study (1) assembled a sample of young adult IDUs, among whom hepatitis C infection prevalence was still moderate, (2) measured incident HCV infection, and (3) determined the risk for seroconversion associated with specific forms of sharing injection paraphernalia.METHODS: Between 1997 and 1999, 702 IDUs, 18-30 years old, were interviewed and screened for antibodies to HCV at baseline and at 6 and 12 months post-baseline. Participants were recruited through street outreach, advertising and chain-referral from ethnically diverse neighborhoods in metropolitan Chicago. Data were analyzed using standard survival statistical methods.RESULTS: HCV prevalence was 27% at enrollment. During 296.5 person-years of observation, we observed 37 HCV seroconversions (incidence: 12.5/100 person-years). The adjusted relative hazard (RH) of seroconversion, after controlling for demographic and drug use covariates, was highest for sharing cookers (RH, 3.58; 95% CI 1.47-8.70), followed by sharing rinse water (RH, 2.16; 95% CI 1.03-4.52), and cottons (RH, 1.84; 95% CI 0.95-3.56). Risk associated with syringe sharing was marginally significant, and backloading was unassociated with hepatitis C seroconversion. Adjusting for syringe sharing, the independent effects of sharing cookers and cottons remained significant, and a final model that included each sharing practice demonstrated that sharing cookers had at the strongest association with seroconversion (RH, 3.03; 95% CI 1.05-8.72).CONCLUSIONS: This study suggests that sharing non-syringe paraphernalia may be an important cause of hepatitis C virus transmission between IDUs.     

Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment

Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.     

High hepatitis C incidence in new injecting drug users: a policy failure?

OBJECTIVE: Evidence of ongoing hepatitis C (HCV) transmission among injecting drug users (IDUs) suggests a need for a better understanding of seroconversion characteristics among new IDUs and other vulnerable subgroups. This study aimed to determine incidence of HCV and associated risk factors among new IDUs in Sydney. METHODS: IDUs who had injected drugs in the past six months and who were unaware of their antibody HCV status or knew their serostatus to be negative were recruited through street-based outreach, methadone clinics and needle and syringe programs in south-western Sydney. Anti-HCV negative IDUs (n = 215) were enrolled and followed-up at 3-6 monthly intervals. New IDUs (n = 204) were defined as aged below 30 years or injecting for < or = 6 years at baseline. RESULTS: A total of 61 seroconversions were observed and incidence was 45.8 per 100 person years. Independent predictors of seroconversion were duration of injecting < 1 year (IRR = 3.10; 95% CI 1.47-6.54), female gender (IRR = 2.0; 95% CI 1.16-3.45), culturally and linguistically diverse background (CALDB) (IRR = 2.03; 95% CI 1.06-3.89) and intravenous cocaine use (IRR = 2.37; 95% CI 1.26-4.44). While new IDUs shared common risk factors, strong associations were observed between HCV seroconversion and sharing syringes, sharing other injecting equipment and backloading in CALDB new IDUs. CONCLUSION: Incidence of HCV infection among new IDUs in Sydney is unacceptably high. IMPLICATIONS: Extremely high rates of incident infection among newly initiated CALDB IDUs indicate an urgent need for enhanced policy and resource commitments to reduce the vulnerability of this group to HCV and other blood-borne infections.     

四川省10县（市）静脉吸毒人员针具使用中艾滋病高危行为分析

目的了解四川省10县（市）静脉吸毒人群针具使用中的高危行为,为制定针对该人群有效干预措施提供科学依据。方法用滚雪球法在西昌、达县、大竹等10县（市）的社区中寻找静脉吸毒者,采用问卷对其针具使用中的高危行为进行调查。结果42．77％的吸毒者最近1个月每天注射吸毒2～3次;10县市静脉吸毒人员最近1次和最近6个月注射器共用率分别为18．35％和40．63％,最近1个月静脉吸毒时,使用他人注射器的共用率为33．98％,将自己使用过的注射器给予他人的共用率为34．81％,其他吸毒用具共用率为45．51％;最近6个月注射器共用率、最近1个月注射器共用率、最近1个月将使用过的注射器给予他人的共用率、最近1个月其他吸毒用具的共用率随吸毒年限的增加呈增高的趋势。结论四川省10个项目县静脉吸毒人群中共用注射器的形势较为严峻,建议给予宣传咨询、针具交换、免费提供漂白粉等综合措施以控制艾滋病的传播和流行。     

Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4.6-13.4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.     

Hepatitis C virus incidence among injecting drug users on opioid replacement therapy

OBJECTIVE: To determine hepatitis C virus (HCV) incidence among injecting drug users (IDUs) receiving opioid replacement therapy (ORT). METHODS: A retrospective cohort study was established in a primary care drug dependency treatment clinic. The cohort included all IDUs who commenced ORT after January 1996 with an initial anti-HCV antibody negative result and repeat testing prior to July 2003. HCV incidence was estimated for all subjects, with further comparison among those with continuous versus interrupted ORT. RESULTS: Fifty-four subjects were initially HCV antibody negative and had repeat testing. Five cases of HCV antibody seroconversion occurred during a total follow-up period of 131.1 person years (py), an incidence of 3.8/100 py (95% CI 1.2-8.9/ 100 py). Four seroconversions occurred in the subgroup with interrupted ORT (n=20), an incidence of 7.4/100 py (95% CI 2.0-18.9/100 py), compared with one seroconversion in the subgroup with continuous ORT (n=34), an incidence of 1.3/100 py (95% CI 0.03-7.3/100 py). CONCLUSIONS: HCV incidence among IDUs receiving ORT in our clinic was relatively low. Those IDUs without interruptions to their treatment appeared to be at particularly low risk of HCV infection. These findings support the role of ORT in HCV prevention for IDUs.     

种子招募的静脉吸毒人群高危行为及HIV、HCV和梅毒感染特征

目的：了解在四川省凉山州地区队列组建中不同招募途径的静脉吸毒人群高危行为及HIV、HCV和梅毒感染特征情况。方法：在队列组建时调查研究对象的招募方式、社会人口学和高危行为特征，采集血样检测HIV、HCV和梅毒感染情况。结果：在379名招募的静脉吸毒人群中，309人（81．5％）是通过种子推荐来的，70人（18．5％）是从其他途径获得信息来的。种子介绍的与其他方式招募的研究对象在民族构成、近3个月静脉注射吸毒频率、近3个月海洛因混合安定使用频率差异有统计学意义。近3个月毒品使用的其他方式、注射器具共用情况、性行为和血样HIV、HCV和梅毒检测结果上差异无统计学意义（P〉O,05）。结论：采用应答驱动抽样方法是招募静脉吸毒人员行之有效的方法，但尚需进一步探讨其对参加者高危行为特征与血清学检测结果的影响。