Prevalence of hepatitis C infection among intravenous drug users in Shanghai

AIM:To characterize the prevalence of hepatitis C virus(HCV)infection among Chinese intravenous drug users(IDUs).METHODS:A total of 432 adult IDUs(95 women and337 men)in Shanghai were included in the study.The third-generation Elecsys Anti-HCV assay(Roche Diagnostics GmbH,Sandhofer Strasse 116,D-68305,Mannheim,Germany)was used to screen for antibodies against HCV.The RIBA strip,a supplemental antiHCV test with high specificity,was performed on all of the samples that tested positive during the initial screening.All of the anti-HCV positive samples were analyzed with a Cobas TaqMan 48 Analyzer(Roche Diagnostics)for direct detection of HCV RNA.All of the HCV RNA-positive samples were sequenced for genotype determination.RESULTS:The preliminary screening identified 262(60.6%)subjects who were seropositive for HCV.Of the 62 females and 200 males seropositive subjects,16(16.7%)and 65(19.3%),respectively,were confirmed by RIBA,yielding an overall HCV seropositive rate of18.8%.Four female(6.5%)and 14 male(7.0%)subjects tested positive for HCV RNA,indicating an active infection rate of 4.2%for the entire study population.The 18 HCV RNA-positive serum samples were genotyped.Seven individuals were genotype 1b,and four were genotype 1a.One individual each was infected with genotypes 2a,2b and 3a.Four subjects were coinfected with multiple strains:two with genotypes 1a and 2a,and two with genotypes 1b and 2a.The active infection rate among HCV-seropositive individuals was22.2%,which was significantly lower than most estimates.CONCLUSION:The prevalence of HCV is relatively low among IDUs in Shanghai,with a spontaneous recovery rate much higher than previous estimates.

Epidemiology of Hepatitis B,C,D and G Viruses and Cytokine Levels among Intravenous Drug Users

To investigate the features of various hepatitis virus infection in intravenous drug users （IVDU）, we conducted an epidemiological survey of hepatitis viruses including hepatitis B virus （HBV）, hepatitis C virus （HCV）, hepatitis D virus （HDV） and hepatitis G virus （HGV） in IVDU. The correlation of Tn lymphocyte cytokine and hepatitis virus infection was examined. A. study population of 406 IVDU consisted of 383 males and 23 females. HBV-DNA and HCV-RNA were detected by fluorescence quantitative polymerase chain reaction. HBsAg, HBeAg, anti-HBc, anti-HCV, HDV-Ag and anti-HGV were assayed by ELISA. The levels of cytokines of TH1 and TH2 were measured by ELISA. The similar indices taken from 102 healthy persons served as controls. The infection rate of each virus among IVDU was 36.45% for HBV, 69. 7 % for HCV, 2.22 % for HDV, and 1.97 % for HGV, respectively. The co-infection rate of HBV and HCV was detected in 113 of 406 （27. 83 %）. In contrast, among controls, the infection rate was 17.65% for HBV and 0% for the other hepatitis viruses. The levels of PHA-induced cytokines （IFN-γ and IL-4） and the level of serum IL-2 were obviously decreased in IVDU. On the other hand, the level of serum IL-4 was increased. The IFN-γ level was continuously decreased when the IVDU was infected with HBV/HCV. In conclusion, HBV and HCV infection were common in this population of IVDU and they had led to a high incidence of impaired TH 1 cytokine levels.

Study on the blood-borne virus co-infection and T lymphocyte subset among intravenous drug users

AIM: To investigate the features of various blood- borne virus infections and co-infection in intravenous drug users (IDUs), and to examine the correlation of T lymphocyte subsets with virus co-infection. METHODS: Four hundred and six IDUs without any clinical manifestation of hepatitis and 102 healthy persons were enrolled in this study. HBV-DNA and HCV-RNA were detected by fluorescence quantitative PCR. HBsAg, HBeAg, anti-HBc, anti-HCV, HDV-Ag, anti-HGV, anti-HIV, and HCMV-IgM were assayed by enzyme-linked immunosorbent assay (ELISA) and immunochromatographic tests. The levels of Th1 and Th2 cytokines were measured by ELISA and radioactive immune assay (RIA). The T lymphocyte subpopulation was detected by using fluorescence immunoassay. The similar indices taken from the healthy persons served as controls. RESULTS: The viral infection rate among IDUs was 36.45% for HBV, 69.7% for HCV, 47.3% for HIV, 2.22% for HDV, 1.97% for HGV, and 3.45% for HCMV. The co- infection rate of blood-borne virus was detected in 255 of 406 (62.81%) IDUs. More than 80% (161/192) of subjects infected with HIV were co-infected with the other viruses, such as HBV, HCV. In contrast, among the controls, the infection rate was 17.65% for HBV and 0% for the other viruses. Our investigation showed that there was a profound decrease in the proportion of CD4/CD8 and the percentage of CD3 and CD4, but not in the percentage of CD8. The levels of PHA-induced cytokines (IFN-γ and IL-4) and serum IL-2 were obviously decreased in IDUs. On the other hand, the level ofserum IL-4 was increased. The level of IFN-γ and the percentage of CD4 were continuously decreased when the IDUs were infected with HIV or HIV co-infection. IDUs with HIV and HBV co-infection was 15.1% (29/192). Of those 29 IDU with HIV and HBV co-infection, 51.72% (15/29) and 37.93% (11/29) were HBV-DNA-positive and HBeAg-positive, respectively. But, among IDUs without HIV infection, only 1.68% (2/119) of cases were HBV- DNA-positive. CONCLUSION: HCV, HBV and HIV infections are common in this population of IDU, leading to a high incidence of impaired Th1 cytokine levels and CD4 lymphocyte. IDUs with HIV and HBV/HCV co-infection have lower expression of Th1 cytokine with enhancement of the Th2 response. HIV may be causing HBV replication by decreasing Th1 function.

Estimating the Size of an Injecting Drug User Population

This article describes a sampling and estimation scheme for estimating the size of an injecting drug user (IDU) population by combining classical sampling and respondent-driven sampling procedures. It is designed to use the information from harm reduction programs, especially, Needle Exchange Programs (NEPs). The approach involves using respondent-driven sampling design to collect a sample of injecting drug users who appear at site of NEP in a certain period of time and to obtain retrospective self-report data on the number of friends among the IDUs and number of needles exchanged for each sampled injecting drug user. A methodology is developed to estimate the size of injecting drug users who have ever used the NEP during the fixed period of time, and which allows us to estimate the proportion of injecting drug users in using NEP. The size of the IDU population is estimated by dividing the total number of IDUs who using NEPs during the period of time by the estimated proportion of IDUs in the group. The technique holds promise for providing data needed to answer questions such as “What is the size of an IDU population in a city?” and “Is that size changing?” and better understand the dynamics of the IDU population. The methodology described here can also be used to estimate size of other hard-to-reach population by using information from harm reduction programs.

Prevalence of Kaposi's sarcoma-associated herpesvirus among intravenous drug users： a systematic review and meta-analysis

Intravenous drug users(IDUs) have been demonstrated to be highly vulnerable to HIV/AIDS.Nevertheless, the prevalence of Kaposi's sarcoma associated herpesvirus(KSHV), an important co-infected agent with HIV, among this population remained obscure. We conducted a systematic review on the epidemiological features of KSHV among IDUs worldwide. Eligible studies were retrieved from 6 electronic databases(Pub Med, EMBASE, Web of Science, CBM, CNKI and Wanfang).We calculated the pooled prevalence and 95% confidence interval(CI) overall and among subgroups using either random-effects model or fixed-effects model depending on between-study heterogeneity. The potential publication bias was assessed by the Egger's test. A meta-regression analysis was performed to explore the sources of heterogeneity. Finally, twenty-two studies with a total sample of 7881 IDUs were included in the analysis. The pooled prevalence of KSHV was14.71%(95% CI 11.12%–19.46%) among IDUs. Specifically, KSHV prevalence was 10.86%(95% CI6.95%–16.96%) in HIV-negative IDUs, and 13.56%(95% CI 10.57%–17.38%) in HIV-positive IDUs.Moreover, prevalence among IDUs from the three continents involved in the current study was similar:16.10%(95%CI 7.73%–33.54%) in Asia; 14.22%(95%CI 8.96%–22.57%) in Europe and 14.06%(95%CI11.38%–17.37%) in America. Globally, IDUs are at higher risk of the KSHV infection when compared with the general population, regardless of geographical region or HIV-infection status.

IDU大规模社会网络及其HIV传播模拟

引入复杂Agent网络模型建立注射吸毒(IDU)共享网络的HIV传播模拟模型。在传统无标度网络配置模型的基础上,通过增加邻域选择机制和三角形形成机制,提出了一种能应用于大规模病毒传播的IDU社会网络生成和演化算法。模型可实现指数可调幂律度分布、高聚类系数和度-度相关等社会网络特征;网络中的边可以断开、重连,网络中的节点可以退出、进入,网络具有动态特性。网络中节点Agent模型中包括个体的行为、病程及个体对疾病干预措施的响应机制,通过节点Agent和网络的协同作用,实现个体行为、个体之间共用注射器吸毒构成的社会网络和干预政策耦合演化的HIV传播模拟模型。对生成的网络进行了社会网络参数度量,利用云南省的数据对吸毒网络HIV传播干预情景进行仿真研究。

四种方法在玉溪市IDU人群HIV-1感染态势评估中的应用

目的为避免评估方法单一性带来的局限性,采用四种方法对玉溪市2007-2012年静脉注射吸毒人群(IDU)人类免疫缺陷病毒-1(HIV-1)感染态势进行评估,为艾滋病防治效果及策略的调整提供科学参考。方法采用哨点监测、BED-CEIA,ML-PA,阴性队列四种方法对2007-2012年IDU进行HIV感染监测并通过感染率、新发感染率评估感染态势。结果哨点监测获得的2007-2012年IDU的HIV-1感染率为10.28%,15.38%,15.03%,13.04%,11.96%和12.31%;BED-CEIA检测为0.33/100人年、0.98/100人年、1.47/100人年、1.33/100人年、0和0.36/100人年;阴性队列为0.00/100人年、0.54/100人年、1.21/100人年、1.01/100人年、1.04/100人年和0.75/100人年;ML-PA检测为0.83/100人年、0/100人年、0.42/100人年、0/100人年和0.87/100人年。结论四种HIV-1流行态势监测结果均显示玉溪市静脉注射吸毒人群近年HIV-1感染处于较低水平。

四川省某市戒毒所静脉吸毒人员艾滋病相关行为及知识调查

目的 了解静脉吸毒人员艾滋病相关行为和艾滋病认知的当前情况。方法 对四川省某市戒毒所内强制或自愿接受戒毒的 4 8人进行问卷调查。结果 本次调查对象男性占 75 .0 % ,初中以下文化层次者占 83.3% ,城市人口占 83.0 % ,无业及特殊职业人员居多。首次吸毒年龄最小为 11岁 ,城市早于农村 (F=3.898,P=0 .0 2 9)。吸毒原因中 ,由于好奇而吸毒的占 5 8.1%。吸毒方式中混合吸者占 70 .8%。有静脉吸毒史者中 ,5 7.1%的人与他人共用注射器。共用注射器者 ,重复使用注射器的情况占 6 6 .7% ,6 2 .5 %的人称是与固定的伙伴共用。静脉吸毒者的性生活中 ,约 79.5 %有临时性伴 ,有多个性伴者约占 6 8.75 % ,而安全套的使用率不到 4 0 %。结论 静脉吸毒人群的吸毒行为和性行为中存在很多能促进 HIV传播的高危因素。

云南省首轮静脉吸毒人群艾滋病感染行为监测结果分析

目的 了解静脉吸毒人群中艾滋病相关知识水平及其危险行为;探索在中国开展行为监测的可行性和标准操作程序。方法 采用双阶段概率抽样对静脉吸毒人群开展一对一问卷调查。结果 艾滋病相关知识水平较低;9％的静脉吸毒者最近一次吸毒时与他人共用注射器,最近1个月从不与他人共用注射器的比例为57％,36％的静脉吸毒者在过去1年内与非固定性伴有性行为,8％的男性静脉吸毒者有嫖娼行为,21％的女性静脉吸毒者有卖淫行为。结论 1)静脉吸毒人群中的艾滋病感染的危险行为水平较高,是我省艾滋病持续蔓延的重要促进因素;2)建议加强对高危人群的艾滋病知识宣传教育和干预力度;3)行为监测在云南的开展是可行的,所获得的行为学信息是我省艾滋病监测体系的重要组成部分。

温州市吸毒人群输血传播病毒感染的检测分析

目的 :了解我市静脉吸毒者输血传播病毒 (TTV)感染情况。方法 :采集静脉吸毒者血液标本 ,分离血清 ,用半巢式聚合酶链式反应 (PCR)检测TTV。结果 :共检测 30 6例 ,检出TTV阳性 2 3例 ,阳性率为 7 5 2 %。吸毒时间≤ 1a者TTV阳性率较低 ,为 4 31% ,而 >1a者阳性率较高 ,为 14 4 3% ,两者比较差异有显著性 (χ2 =9 77,P <0 0 1)。不同性别和不同血型者的TTV感染率比较差异无显著性 (P >0 0 5 )。结论 :温州地区静脉吸毒者是TTV感染的高危人群 ,应采取控制措施预防和减少TTV在吸毒人群中的传播。

静脉吸毒者肝功能和细胞免疫功能及丙型肝炎感染状况

目的探讨毒品对人体肝功能和细胞免疫的影响。方法按常规抽血测定静脉吸毒组和健康对照组人员血常规、肝功能、免疫球蛋白IgG、IgA和IgM含量及CD4+细胞绝对值、CD8+细胞绝对值和CD4/CD8比值。结果(1)静脉吸毒组肝功能指标丙氨酸氨基转移酶(ALT)为(71.59±45.00)U/L,高于对照组(19.39±8.59)U/L,差异有统计学意义(P<0.05),但天冬氨酸氨基转移酶(AST)、总蛋白含量(TP)和总胆固醇(CHOL)却低于健康对照组,差异有统计学意义(P<0.05);(2)静脉吸毒组白细胞(WBC)绝对值为(5.99±1.74)×109/L,淋巴细胞(LYM)绝对值为(1.79±0.55)×109/L,低于健康对照组,差异有统计学意义(P<0.05);静脉吸毒组红细胞(RBC)计数、血小板(PLT)计数与健康对照组相比差异无统计学意义(P>0.05)。(3)静脉吸毒组CD8+细胞数绝对值低与对照组,差异有统计学意义(P<0.05),CD4+细胞数绝对值和CD4/CD8比值两组间差异无统计学意义(P>0.05);(4)静脉吸毒组免疫球蛋白IgM含量为(1.70±0.71)g/L高于健康对照组,差异有统计学意义(P<0.05),而免疫球蛋白IgG、IgA差异无统计学意义。(5)41例静脉吸毒者中丙型肝炎抗体(抗-HCV-IgG)阳性者34例,阳性率是82.9%。结论静脉注射毒品导致人体肝功能受损和丙肝感染率增高,降低了人体的免疫力。

云南省某市女性性工作者HIV感染及其危险因素调查

目的了解云南省某市女性性工作者(FSWs)艾滋病病毒(HIV)和性传播疾病(STD)的感染情况及HIV感染相关危险因素。方法招募FSWs调查其一般人口学及行为学资料,采集静脉血进行HIV、单纯疱疹病毒2型(HSV-2)和梅毒血清学检测,采集尿液进行尿吗啡检测,采集宫颈分泌物进行淋球菌和沙眼衣原体检测,采集阴道分泌物进行阴道毛滴虫检测。结果共收集血液标本737份,其中76份经确认为HIV抗体阳性,感染率为10.3%,梅毒感染率为7.5%,HSV-2感染率为68.1%。共收集阴道和宫颈分泌物标本各737份,淋病感染率为8.3%,沙眼衣原体感染率为25.9%,阴道毛滴虫感染率为10.6%。共收集尿标本739份,吗啡阳性率为15.6%。多因素logistic回归模型分析显示,与HIV感染有关的危险因素是:低档性服务场所服务,静脉注射吸毒,过去一年出现下腹部疼痛,生殖器溃疡,外阴增生物,从事性服务时间≥5年,HSV-2阳性。结论当地FSWs的HIV和STD感染率较高,需针对该人群采取有效的干预措施,及时治疗STD,控制HIV的传播流行。

2004年东莞市395名吸毒人员HIV、梅毒感染状况分析

目的:了解东莞市吸毒人员HIV、梅毒的感染状况,为干预措施的制定提供理论数据。方法:对吸毒人员吸毒方式、性行为等进行问卷调查,并采血样检测HIV抗体、梅毒抗体。结果:395名吸毒者中,HIV、梅毒感染率分别为6.84%和9.62%。单一口吸者、口吸并静注者、单一静注者HIV感染率分别为0%、8.14%、23.08%;梅毒感染率分别为10.81%、9.30%、7.69%;这3种吸毒方式之间HIV感染率有显著性差异,单一静注者感染率最高。有静脉注射史者(包括单一静注者和口吸并静注者)占71.9%(284/395),其中共用针具者与非共用针具者HIV感染率分别为18.42%(21/114)、3.53%(6/170),两者相比有显著性差异;非共用针具静注者与单一口吸者之间HIV感染率并无显著性差异。以上各组间梅毒感染率无显著性差异。本次调查中吸毒者不同性行为(有无用安全套)之间HIV、梅毒的感染率无显著性差异。结论:本市吸毒人群HIV的感染率处于中等水平,共用注射器吸毒是HIV感染的主要因素。有必要在吸毒人群中开展艾滋病知识的宣传和干预。

吸毒人群HIV阳性者高危行为状况分析

目的了解静脉吸毒人群HIV感染者高危险行为现状,为更好管理和开展宣传干预HIV感染者提供科学依据。方法采用滚雪球抽样方法,对南宁市社区379例吸毒人群进行问卷调查及HIV抗体检测,分析静脉吸毒人群HIV感染者高危行为情况。结果静脉吸毒人群HIV感染率为22.2%,男高于女。HIV感染者最近6个月共针率为65.5%,与配偶或同居者、临时性伴、商业性伴发生性行为安全套使用率分别为15.1%、17.2%、15.0%,出现相关性病症状23.8%。结论吸毒人群中普遍存在高危行为,应加强对吸毒人群的监测、宣传教育和行为干预,通过干预平台来预防和控制艾滋病。

吸毒人员HCV感染危险因素的Logistic回归分析

目的了解美沙酮门诊吸毒人员丙肝病毒(Hepatitis C virus,HCV)感染流行情况及相关因素。方法基于社区美沙酮门诊吸毒人员的基线调查,收集宜昌市572名吸毒人员相关社会因素和HCV检测情况,进行单因素和多因素Logistic回归分析。结果 572名吸毒人员中,男446人(78.0%),女126人(22.0%),平均年龄37岁,平均吸毒年限13年,有过注射吸毒史的517人占90.4%,曾经共用过注射器的140人(24.5%);HCV感染情况经过检测,572人中HCV阳性498人,阳性率87.06%。单因素分析结合Logistic回归分析显示:婚姻状况、吸毒年限、是否注射毒品是HCV感染的主要危险因素。结论尽管湖北省吸毒人群HIV感染不高,但HCV感染率很高,两者传播方式有明显差异,应该加强吸毒人群的HCV感染防治。

大理地区静脉吸毒人群隐孢子虫感染调查

目的调查静脉吸毒人群隐孢子虫的感染情况,初步研究性别、年龄、民族和吸毒年限与感染的关系。方法收集静脉吸毒者粪便标本500份,采用改良抗酸染色法检查粪便中的隐孢子虫卵囊。结果500份粪便中84份查到隐孢子虫卵囊,总感染率为16.8%;不同性别、年龄和民族的吸毒者隐孢子虫感染率有一定差别,但差异无统计学意义;随着吸毒时间的延长,隐孢子虫感染率也相应增高,不同吸毒年限感染率差异有统计学意义。结论静脉吸毒人群隐孢子虫的感染率高于普通人群,应加强对该人群的防治工作。

静脉药瘾者HIV重叠HBV/HCV感染研究

目的探讨人类免疫缺陷病毒(HIV)重叠乙型肝炎病毒(HBV)/丙型肝炎病毒(HCV)感染时,HIV对机体T辅助细胞亚群的影响及HBV/HCV核酸载量的变化。方法以静脉药瘾者(IVDUs)为研究对象,采用ELISA、免疫层析法和PCR法检测病毒感染指标,用ELISA法和间接免疫荧光法检测T细胞亚群。结果IVDUs的CD3、CD4细胞、干扰素(IFN)-γ和白细胞介素(IL)-4产生减少,IVDUs存在HIV感染时CD3、CD4细胞和IFN-γ产生进一步降低,HIV感染与HBV-DNA和HBeAg表达相关。结论IVDUsT细胞亚群功能减弱,HIV促进HBV复制,重叠感染可进一步干扰辅助性T细胞(TH)1/T2细胞平衡,降低机体细胞免疫功能。

2003-2005年南充市注射吸毒人群艾滋病高危行为监测

目的 了解对注射吸毒人群进行艾滋病高危行为干预的效果。方法 于2003-2005年采用重复横断面调查方法对顺庆城区注射吸毒人群进行行为学监测。结果 调查注射吸毒人员1096名，年龄20-40岁为主（82．67％），男女之比为3．53：1，文化程度以初中及其以下为主占（81．66％）。干预后对艾滋病传播知识正确认识率提高到95％以上；共用针具率：最近1次由22．14％下降为9．97％，最近1月由22．92％下降为16．07％，最近6月由40．70％下降为18．56％；安全套使用率：与非固定性伴由18．37％上升到36．36％，与商业性伴由37．83％上升到65．52％。结论 对注射吸毒者开展综合干预是改变高危行为，遏制艾滋病传播的有效措施。

新疆静脉吸毒者中TTV、HBV和HCV感染情况分析

目的:探讨新疆静脉吸毒者中输血传播病毒 (TTV)、乙型肝炎病毒 (HBV)、丙型肝炎病毒 (HCV)感染的特点 ,为防止感染提供理论依据。 方法:采用套式 PCR技术检测 10 2例静脉吸毒者 (IVDUs)血清中 TTV-DNA,用酶联免疫吸附试验 (EL ISA)检测 HCV抗体 (抗 HCV)及 HBV血清学标志物 ,根据 TTV- DNA检测结果分为 TTV - DNA阳性组和阴性组 ,比较两组人群的 HBV、HCV及 HBV/HCV感染情况。结果:静脉吸毒者 TTV-DNA阳性组和阴性组在民族、年龄、性别、吸毒时间、吸毒剂量、有无多性伴侣、HCV和 HBV病毒混合感染等方面无统计学差异 ,而在是否共用注射器上差异有统计学意义 (P <0 .0 5 )。 33例 TTV- DNA阳性静脉吸毒者中 ,7例为单纯 TTV感染 ,2 6例重叠 HCV或 HBV感染 ,其中 TTV、HCV、HBV三重感染 8例。结论 :TTV、HCV在新疆静脉吸毒者中有较高的阳性率 ,静脉吸毒人群是 TTV、HCV感染的高危人群。 TTV可以单独感染 ,但与 HBV、HCV的重叠感染率也较高。

静脉药瘾者丙型肝炎病毒感染及其相关因素的分析

目的了解静脉药瘾者丙型肝炎病毒(HCV)感染状况及其影响因素。方法381例静脉药瘾者作为研究对象,采集血清,用酶联免疫吸附法(ELISA)和聚合酶链反应(PCR)观察HCV感染和常见的血源传播病毒的感染指标。结果静脉药瘾者中抗HCV阳性261人(68.5%),感染率与当地正常人群比较,差异有统计学意义(P<0.01),单因素分析表明HCV感染与吸毒史长短、共用注射器者和重叠HIV/HBV感染相关。Logistic逐步回归分析主要因素是HIV感染、吸毒史和共用注射器。结论静脉药瘾者是HCV感染的高危人群,而吸毒史长、共用注射器和伴发HIV/HBV感染时,使机体易感性增高,静脉药瘾者是丙型肝炎的重点防治对象。