Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis,The Lancet Gastroenterology & Hepatology

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Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis
The Lancet Gastroenterology & Hepatology ( IF 30.9 ) Pub Date : 2023-03-27 , DOI: 10.1016/s2468-1253(23)00018-3
Adelina Artenie ₁ , Jack Stone ₁ , Hannah Fraser ₁ , Daniel Stewart ₂ , Chiedozie Arum ₃ , Aaron G Lim ₁ , Anna L McNaughton ₁ , Adam Trickey ₁ , Zoe Ward ₁ , Daniela Abramovitz ₄ , Michel Alary ₅ , Jacquie Astemborski ₆ , Julie Bruneau ₇ , Steven J Clipman ₈ , Carla S Coffin ₉ , Sara Croxford ₁₀ , Kora DeBeck ₁₁ , Eva Emanuel ₁₂ , Kanna Hayashi ₁₃ , Joumana G Hermez ₁₄ , Daniel Low-Beer ₁₅ , Niklas Luhmann ₁₅ , Gisela Macphail ₁₆ , Lisa Maher ₁₇ , Norah E Palmateer ₁₈ , Eshan U Patel ₁₉ , Rachel Sacks-Davis ₂₀ , Wijnand Van Den Boom ₂₁ , Daniela K van Santen ₂₂ , Josephine G Walker ₂₃ , Matthew Hickman ₁ , Peter Vickerman ₁ ,

Affiliation

Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Public Health Speciality Training Programme, South West, Bristol, UK.
Yale School of Medicine, Yale University, New Haven, CT, USA.
School of Medicine, University of California, San Diego, CA, USA.
Centre de recherche du CHU de Québec-Université Laval, Québec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada.
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Public Health and Clinical Directorate, UK Health Security Agency, London, UK.
School of Public Policy, Simon Fraser University, Vancouver, BC, Canada; BC Centre on Substance Use, Vancouver, BC, Canada.
Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK.
BC Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Infectious Diseases, CUPS Liver Clinic, Calgary, AB, Canada.
Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia.
Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Background

Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender.

Methods

In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle–Ottawa scale. This study is registered with PROSPERO, CRD42020220884.

Findings

Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987–2021 for HIV and 1992–2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3–2·3; I²=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0–14·6; I²=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2–1·8; I²=66·9%) and HCV (1·5, 1·3–1·8; I²=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1–1·6; I²=55·3%) and HCV (1·2, 1·1–1·3; I²=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6–7), indicating moderate risk.

Interpretation

Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs.

Funding

Canadian Institutes of Health Research, Fonds de recherche du Québec–Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.

中文翻译：

注射吸毒者中艾滋病毒和丙型肝炎病毒的发病率以及与年龄和性别的关联：全球系统评价和荟萃分析

背景

测量注射吸毒者 (PWID) 中艾滋病毒和丙型肝炎病毒 (HCV) 感染的发病率是跟踪消除毒品进展的关键。我们的目的是总结关于吸毒者中艾滋病毒和丙型肝炎原发性发病率的全球数据以及与年龄和性别的关系。

方法

在这项系统回顾和荟萃分析中，我们通过搜索 MEDLINE、Embase 和 PsycINFO 更新了吸毒者中 HIV 和 HCV 发病率研究的现有数据库，捕获了 2000 年 1 月 1 日至 2022 年 12 月 12 日之间发表的研究，没有任何语言或内容。研究设计限制。我们联系了已确定研究的作者以获取未发表或更新的数据。我们纳入了通过纵向重新测试有感染风险的人或使用近期感染检测来估计发病率的研究。我们使用随机效应荟萃分析汇总了发病率和相对风险（RR；年轻[通常定义为≤25岁]与老年吸毒者；女性与男性）估计值，并使用改良的纽卡斯尔-渥太华量表评估了偏倚风险。本研究已在 PROSPERO 注册，CRD42020220884。

发现

我们更新后的检索发现了 9493 篇出版物，其中 211 篇符合全文审查条件。我们还对现有数据库中的另外 377 条全文记录和通过交叉引用确定的 5 条记录进行了评估。包括28条未发表记录，125条记录符合纳入标准。我们确定了 64 项 HIV 发病率估计值（30 项来自高收入国家 [HIC]，34 项来自低收入或中等收入国家 [LMIC]）和 66 项 HCV 发病率估计值（52 项来自 HIC，14 项来自 LMIC）。 64 例 HIV 病例中的 41 例（64%）和 66 例 HCV 病例中的 42 例（64%）来自单个城市，而不是多城市或全国范围内。对 1987-2021 年 HIV 的估计值和 1992-2021 年 HCV 的估计值进行了测量。 HIV 汇总发病率为每 100 人年 1·7 (95% CI 1·3–2·3； I ² =98·4%)，HCV 汇总发病率为每 100 人年 12·1 (10·0– 14·6； I ² =97·2%）。年轻注射吸毒者感染艾滋病毒（RR 1·5，95% CI 1·2–1·8； I ² =66·9%）和丙型肝炎病毒（1·5，1·3–1·8； I ² =70·6%) 比老注射吸毒者更容易获得。女性感染 HIV（RR 1·4，95% CI 1·1–1·6； I ² =55·3%）和 HCV（1·2、1·1–1·3； I ² = 43·3%）的获得率高于男性。对于 HIV 和 HCV，中位风险偏倚评分均为 6 (IQR 6-7)，表明风险中等。