Epidemic trends and behavioral changes of hepatitis C among different types of drug users in Beijing from 2017 to 2021
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摘要:
目的 了解北京市传统毒品与新型毒品吸毒者丙型病毒性肝炎(简称丙肝)流行趋势及其行为特征变化，为在吸毒人群中开展丙肝防治提供参考。 方法 2017—2021年采取重复横断面研究，对北京市东城区、朝阳区和大兴区拘留所新入所的，并且符合研究对象定义的吸毒者进行问卷调查，获得吸毒人群危险行为特征，并采集血样进行丙型肝炎病毒(hepatitis C virus, HCV)、梅毒和人类免疫缺陷病毒(human immunodeficiency virus, HIV)检测。采用χ2检验分析不同类型吸毒者2017—2021年丙肝流行趋势及其行为特征变化，采用多因素logistic回归分析模型分析不同类型毒品吸毒者感染HCV的危险因素。 结果 2017—2021年北京市吸毒人群HCV总体阳性率为19.9%，其中传统毒品吸毒者HCV阳性率(49.4%)高于新型毒品吸毒者(7.4%)。2019—2021年不同类型吸毒者HCV阳性率均呈上升趋势。传统毒品吸毒者曾经注射过毒品的比例呈逐年增加趋势，从2017年的59.6%增加到2021年的70.3%(χ2=19.215, P=0.001)。2019—2021年新型毒品吸毒者曾经共用注射器的比例呈逐年增加趋势，从2019年的9.5%增加到2021年的15.9%(χ2=23.469, P＜0.001);多因素分析结果显示，北京市传统毒品吸毒者感染HCV的危险因素包括户籍(OR=5.49, 95% CI: 1.41~21.41)、曾经注射过毒品(OR=9.41, 95% CI: 2.39~36.99)、最近1次吸毒后发生性行为(OR=4.61, 95% CI: 1.24~17.18)，曾经注射过毒品是新型毒品吸毒者感染HCV的特有危险因素(OR=12.04, 95% CI: 5.60~25.88, P＜0.001)。 结论 2017—2021年北京市不同类型吸毒者HCV阳性率逐年上升，曾经注射过毒品和最近1次吸毒后发生性行为是吸毒人群HCV阳性率上升的主要原因，应加强对该人群高危行为干预、推广抗病毒治疗，从而降低吸毒人群丙肝的疾病负担。 Abstract:Objective To understand the epidemic trend of hepatitis C and changes of behavioral characteristics among different types of drug users in Beijing from 2017 to 2021, and to provide necessary information for developing targeted hepatitis C treatment and prevention strategy among drug users. Methods From 2017 to 2021, repeated cross-sectional surveys were conducted among drug users in Beijing, blood samples were collected for hepatitis C virus (HCV), syphilis, and HIV testing. Chi-square tests were used to analyze the trends in hepatitis C prevalence and changes in behavioral characteristics among different types of drug users. Multivariate logistic regression models were employed to identify risk factors for HCV infection among these populations. Results The overall prevalence of HCV positive among drug users in Beijing from 2017 to 2021 was 19.9%, The prevalence of HCV infection in different types of drug users had shown an upward trend from 2019 to 2021. Among the traditional drug users, the proportion of injecting drug use increased from 59.6% in 2017 to 70.3% in 2021 (χ2=19.215, P=0.001). Among the new-type drug users, the proportion of injecting drug use increased from 5.9% in 2017 to 10.8% in 2021 (χ2=23.469, P < 0.001). Multivariate analysis showed that the risk factors of HCV infection in traditional drug users included household registration in Beijing (OR=5.49, 95% CI: 1.41-21.41), injecting drug use (OR=9.41, 95% CI: 2.39-36.99), and having sex after drug use (OR=4.61, 95% CI: 1.24-17.18), while the risk factors of HCV infection in new-type drug users was injecting drug use (OR=12.04, 95% CI: 5.60-25.88, P < 0.001). Conclusions The prevalence of HCV infection among different types of drug users in Beijing had been increasing year by year from 2017 to 2021. The continuous existence of injecting drug use and unsafe sexual behavior was the main reason for the increase of hepatitis C among drug users. -
Key words:
- Hepatitis C virus /
- Drug users /
- Human immunodeficiency virus
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表 1 北京市不同类型吸毒者2017—2021年HCV阳性率
Table 1. HCV positive rate in different types of drug users in Beijing from 2017 to 2021
年份
Year调查人数
Number of survey participants毒品类型
Type of drug①HCV阳性率
HCV positivity rate①HCV阳性率
HCV positivity rate①传统毒品
Traditional drugs新型毒品
New types of drugs传统毒品
Traditional drugs新型毒品
New types of drugs2017 2 923 681(23.3) 2 242(76.7) 529(18.1) 316(46.4) 213(9.5) 2018 2 761 696(25.2) 2 065(74.8) 439(15.9) 321(46.1) 118(5.7) 2019 2 336 724(31.0) 1 612(69.0) 416(17.8) 325(44.9) 91(5.6) 2020 970 404(41.6) 566(58.4) 269(27.7) 228(56.4) 41(7.2) 2021 1 120 482(43.0) 638(57.0) 354(31.6) 287(59.5) 67(10.5) 合计Total 10 110 2 987(29.5) 7 123(70.5) 2 007(19.9) 1 477(49.4) 530(7.4) 注：HCV, 丙型肝炎病毒。
①以人数(占比/%)表示。
Note：HCV, hepatitis C virus.
① Number of people (proportion/%).
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表 2 2017—2021年北京市传统毒品吸毒者一般状况及行为特征
Table 2. Demographic and behavioral characteristics in traditional drug users in Beijing from 2017 to 2021
变量
Variable2017年
year2018年
year2019年
year2020年
year2021年
yearχ2值
valueP值
value性别Gender 14.408 0.006 男Male 605(88.8) 601(86.4) 599(82.7) 347(85.9) 398(82.6) 女Female 76(11.2) 95(13.6) 125(17.3) 57(14.1) 84(17.4) 年龄组/岁Age group/years 233.800 ＜0.001 15~＜20 2(0.3) 4(0.6) 1(0.1) 0(0) 2(0.4) 20~＜30 66(9.7) 70(10.0) 39(5.4) 13(3.2) 18(3.7) 30~＜40 157(23.0) 102(14.7) 138(19.1) 33(8.2) 60(12.5) 40~＜50 265(38.9) 252(36.2) 256(35.4) 115(28.4) 121(25.1) 50~＜60 174(25.6) 245(35.2) 258(35.6) 197(48.8) 221(45.9) ≥60 17(2.5) 23(3.3) 32(4.4) 46(11.4) 60(12.4) 户籍Household registration 219.600 ＜0.001 北京市Beijing 373(54.8) 529(76.0) 541(74.7) 363(89.9) 412(85.5) 外省Non-local provinces 308(45.2) 167(24.0) 183(25.3) 41(10.1) 70(14.5) 文化程度Education 58.331 0.088 文盲Illiterate 17(2.5) 24(3.5) 26(3.6) 19(4.7) 20(4.1) 小学Elementary school 122(17.9) 96(13.8) 131(18.1) 37(9.2) 47(9.8) 初中Junior high school 296(43.5) 335(48.1) 296(40.9) 191(47.3) 210(43.6) 高中或中专High school or technical secondary school 190(27.9) 172(24.7) 204(28.2) 127(31.4) 175(36.3) 大专及以上College degree or above 56(8.2) 69(9.9) 67(9.2) 30(7.4) 30(6.2) 曾经注射过毒品Have ever injected drugs 19.215 0.001 是Yes 406(59.6) 427(61.4) 439(60.6) 269(66.6) 339(70.3) 否No 275(40.4) 269(38.6) 285(39.4) 135(33.4) 143(29.7) 曾经共用注射器Syringes were shared 20.188 ＜0.001 是Yes 86(21.2) 75(17.6) 88(20.0) 54(20.1) 35(10.3) 否No 320(78.8) 352(82.4) 351(80.0) 215(79.9) 304(89.7) 最近1年发生性行为Sexual activity in the last year 55.626 ＜0.001 是Yes 425(62.4) 374(53.7) 436(60.2) 175(43.3) 231(47.9) 否No 256(37.6) 322(46.3) 288(39.8) 229(56.7) 251(52.1) 最近1次吸毒后发生性行为Having sex after taking drugs 62.922 ＜0.001 是Yes 164(38.7) 138(36.9) 200(45.9) 25(14.3) 72(31.2) 否No 260(61.3) 236(63.1) 236(54.1) 150(85.7) 159(68.8) 最近1次吸毒后性行为使用安全套
Last post-drug sexual activity using a condom56.641 ＜0.001 是Yes 61(37.2) 47(34.1) 93(46.5) 10(40.0) 60(83.3) 否No 103(62.8) 91(65.9) 107(53.5) 15(60.0) 12(16.7) 最近1年与商业性伴发生性行为
Sexual activity with a commercial partner within the last year31.793 ＜0.001 是Yes 67(15.8) 51(13.7) 89(20.4) 14(8.0) 61(26.4) 否No 358(84.2) 321(86.3) 347(79.6) 161(92.0) 170(73.6) 最近1次与商业性伴性行为使用安全套
Last time using a condom during sexual activity with a commercial partner36.115 ＜0.001 是Yes 46(68.7) 23(45.1) 50(56.2) 10(71.4) 56(91.8) 否No 21(31.3) 28(54.9) 39(43.8) 4(28.6) 5(8.2) 与同性发生肛交(仅男性)
Anal sex with someone of the same sex (men only)9.238 0.055 是Yes 14(2.3) 3(0.5) 13(2.2) 5(1.4) 7(1.8) 否No 591(97.7) 598(99.5) 586(97.8) 342(98.6) 391(98.2) 梅毒Syphilis 12.186 0.012 阳性Positive 8(26.7) 11(34.4) 17(48.6) 6(31.6) 17(68.0) 阴性Negative 22(73.3) 21(65.6) 18(51.4) 13(68.4) 8(32.0) HIV 16.630 0.007 阳性Positive 12(1.8) 4(0.6) 2(0.3) 1(0.2) 1(0.2) 阴性Negative 669(98.2) 692(99.4) 722(99.7) 403(99.8) 481(99.8) 注：HIV，人类免疫缺陷病毒。
Note: HIV, human immunodeficiency virus.
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表 3 2017—2021年新型毒品吸毒者一般状况及行为特征
Table 3. Demographic and behavioral characteristics in synthetic drug users in Beijing from 2017 to 2021
变量
Variable2017年
year2018年
year2019年
year2020年
year2021年
yearχ2值
valueP值
value性别Gender 27.435 ＜0.001 男Male 1 883(84.0) 1 685(81.6) 1 284(79.7) 499(88.2) 531(83.2) 女Female 359(16.0) 380(18.4) 328(20.3) 67(11.8) 107(16.8) 年龄组/岁Age group/years 100.622 ＜0.001 15~＜20 29(1.3) 25(1.2) 14(0.9) 3(0.5) 2(0.3) 20~＜30 596(26.6) 563(27.3) 399(24.7) 101(17.9) 99(15.5) 30~＜40 962(42.9) 847(41.0) 677(42.0) 266(47.0) 297(46.6) 40~＜50 504(22.5) 460(22.3) 375(23.3) 123(21.7) 154(24.1) 50~＜60 140(6.2) 151(7.3) 135(8.4) 65(11.5) 82(12.9) ≥60 11(0.5) 19(0.9) 12(0.7) 8(1.4) 4(0.6) 户籍Household registration 76.409 ＜0.001 北京市Beijing 746(33.3) 744(36.0) 676(41.9) 254(44.9) 310(48.6) 外省Non-local provinces 1 496(66.7) 1 321(64.0) 936(58.1) 312(55.1) 328(51.4) 文化程度Education 58.331 ＜0.001 文盲Illiterate 58(2.6) 64(3.1) 57(3.5) 29(5.1) 27(4.2) 小学Elementary school 462(20.6) 350(16.9) 286(17.8) 96(17.0) 138(21.6) 初中Junior high school 1005(44.8) 832(40.3) 613(38.0) 203(35.9) 207(32.5) 高中或中专High school or technical secondary school 518(23.1) 464(22.5) 372(23.1) 145(25.6) 124(19.4) 大专及以上College degree or above 199(8.9) 355(17.2) 284(17.6) 93(16.4) 142(22.3) 曾经注射过毒品Have ever injected drugs 23.469 ＜0.001 是Yes 133(5.9) 155(7.5) 105(6.5) 28(4.9) 69(10.8) 否No 2 109(94.1) 1 910(92.5) 1 507(93.5) 538(95.1) 569(89.2) 曾经共用注射器Syringes were shared 20.188 ＜0.001 是Yes 14(10.5) 19(12.3) 10(9.5) 3(10.7) 11(15.9) 否No 119(89.5) 136(87.7) 95(90.5) 25(89.3) 58(84.1) 最近1年发生性行为Sexual activity in the last year 66.569 ＜0.001 是Yes 1 192(53.2) 1 205(58.4) 919(57.0) 232(41.0) 314(49.2) 否No 1 050(46.8) 860(41.6) 693(43.0) 334(59.0) 324(50.8) 最近1次吸毒后发生性行为Having sex after taking drugs 34.330 ＜0.001 是Yes 799(67.0) 920(76.4) 640(69.6) 146(62.9) 223(71.0) 否No 393(33.0) 284(23.6) 279(30.4) 86(37.1) 91(29.0) 最近1次吸毒后性行为使用安全套
Last post-drug sexual activity using a condom25.632 ＜0.001 是Yes 449(56.2) 542(58.9) 370(57.8) 95(65.1) 164(73.5) 否No 350(43.8) 378(41.1) 270(42.2) 51(34.9) 59(26.5) 最近1年与商业性伴发生性行为
Sexual activity with a commercial partner within the last year37.602 ＜0.001 是Yes 403(33.8) 451(37.3) 300(32.6) 48(20.7) 136(43.3) 否No 791(66.2) 758(62.7) 619(67.4) 184(79.3) 178(56.7) 最近1次与商业性伴性行为使用安全套
Last time using a condom during sexual activity with a commercial partner28.734 ＜0.001 是Yes 305(75.7) 319(70.4) 202(67.3) 36(75.0) 121(89.0) 否No 98(24.3) 134(29.6) 98(32.7) 12(25.0) 15(11.0) 与同性发生肛交(仅男性)
Anal sex with someone of the same sex (men only)9.238 0.055 是Yes 69(3.7) 41(2.4) 52(4.0) 14(2.8) 47(8.9) 否No 1 814(96.3) 1 644(97.6) 1 232(96.0) 485(97.2) 484(91.1) 梅毒Syphilis 11.970 0.018 阳性Positive 149(55.4) 104(49.3) 65(44.5) 34(61.8) 41(40.2) 阴性Negative 120(44.6) 107(50.7) 81(55.5) 21(38.2) 61(59.8) HIV 64.384 ＜0.001 阳性Positive 23(1.0) 29(1.4) 25(1.6) 11(1.9) 35(5.5) 阴性Negative 2 219(99.0) 2 036(98.6) 1 587(98.4) 555(98.1) 603(94.5) 注：HIV，人类免疫缺陷病毒。
Note: HIV, human immunodeficiency virus.
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表 4 不同类型吸毒者HCV阳性的单因素分析
Table 4. Single factor analysis of hepatitis C positive rate in different types of drug users
变量
Variable传统毒品吸毒者HCV检测
HCV testing for traditional drug users新型毒品吸毒者HCV检测
HCV testing for new drug users阳性人数
Number of positives阳性率
Positive rate/%χ2值
valueP值
value阳性人数
Number of positives阳性率
Positive rate/%χ2值
valueP值
value性别Gender 5.150 0.023 2.913 0.088 男Male 1 239 48.6 452 7.7 女Female 238 54.5 78 6.3 年龄组/岁Age group/years 159.154 ＜0.001 297.358 ＜0.001 15~＜20 3 33.3 3 0 20~＜30 40 19.4 44 2.5 30~＜40 171 34.9 142 4.7 40~＜50 571 56.6 230 14.2 50~＜60 606 55.3 105 18.3 ≥60 86 48.3 6 11.1 户籍Household registration 129.108 ＜0.001 74.379 ＜0.001 北京市Beijing 1 233 55.6 234 5.3 外省Non-local provinces 244 31.7 296 10.8 文化程度Education 38.067 ＜0.001 40.851 ＜0.001 文盲Illiterate 52 49.1 26 11.1 小学Elementary school 194 44.8 137 10.3 初中Junior high school 727 54.7 205 7.2 高中或中专High school or technical secondary school 413 47.6 121 7.5 大专及以上College degree or above 91 36.1 41 3.8 曾经注射过毒品Have ever injected drugs 694.887 ＜0.001 856.302 ＜0.001 是Yes 1 278 68.0 329 5.0 否No 199 18.0 201 41.0 曾经共用注射器Syringes were shared 1.263 0.261 15.219 ＜0.001 是Yes 239 70.7 37 64.9 否No 1 039 67.4 164 37.9 最近1年发生性行为Sexual activity in the last year 22.114 ＜0.001 0.081 0.776 是Yes 747 45.5 291 7.5 否No 730 54.2 239 7.3 最近1次吸毒后发生性行为Having sex after taking drugs 11.531 0.001 9.809 0.002 是Yes 239 39.9 229 8.4 否No 507 48.7 62 5.5 最近1次吸毒后性行为使用安全套
Last post-drug sexual activity using a condom6.864 0.009 13.350 ＜0.001 是Yes 92 33.9 110 6.8 否No 147 44.8 119 10.7 最近1年与商业性伴发生性行为
Sexual activity with a commercial partner within the last year0.230 0.632 0.007 0.934 是Yes 132 46.8 102 7.6 否No 614 45.2 191 7.5 最近1次与商业性伴性行为使用安全套
Last time using a condom during sexual activity with a commercial partner0.532 0.486 1.377 0.241 是Yes 90 48.6 70 7.1 否No 42 43.3 33 9.2 与同性发生肛交(仅男性) Anal sex with someone of the same sex (men only) 0.016 0.899 0.176 0.475 是Yes 20 47.6 15 6.7 否No 1 219 48.6 437 7.7 梅毒Syphilis(ELISA/RPR) 0.172 0.678 0.245 0.261 阳性Positive 38 64.4 41 10.4 阴性Negative 50 61.0 45 11.5 注：HCV, 丙型肝炎病毒; ELISA，酶联免疫吸附测定；RPR，快速血浆反应素试验。
Note: HCV, hepatitis C virus; ELISA, enzyme-linked immunosorbent assay; RPR, rapid plasma reagin.
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表 5 不同类型吸毒者HCV阳性的logistic回归分析
Table 5. Logistic regression analysis of HCV positive rate in different types of drug users
变量
Variable传统毒品Traditional drugs 新型毒品New types of drugs OR值value
(95% CI)P值
valueOR值value
(95% CI)P值
value性别Gender 男Male 1.00 1.00 女Female 1.49(0.58~12.56) 0.568 0.82(0.35~4.76) 0.237 年龄组/岁Age group/years 15~＜20 1.00 1.00 20~＜30 0.60(0.03~13.86) 0.816 1.44(0.03~10.23) 0.706 30~＜40 1.52(0.02~104.29) 0.924 2.64(0.25~15.69) 0.659 40~＜50 2.05(0.07~60.19) 0.954 3.37(0.36~23.32) 0.856 50~＜60 2.02(0.08~55.16) 0.679 3.66(0.95~23.56) 0.715 ≥60 1.57(0.07~37.63) 0.566 2.99(0.66~16.83) 0.800 户籍Household registration 外省Non-local provinces 1.00 1.00 北京市Beijing 5.49(1.41~21.41) 0.017 0.81(0.40~1.64) 0.718 文化程度Education 文盲Illiterate 0.74(0.19~1.861) 0.741 1.00 小学Elementary school 1.43(0.16~24.21) 0.135 0.85(0.02~2.71) 0.437 初中Junior high school 0.97(0.09~11.25) 0.743 0.72(0.27~2.60) 0.690 高中或中专High school or technical secondary school 0.81(0.09~9.89) 0.811 0.83(0.24~2.11) 0.808 大专及以上College degree or above 0.74(0.19~1.86) 0.741 0.56(0.23~2.47) 0.659 曾经注射过毒品Have ever injected drugs 否No 1.00 1.00 是Yes 9.41(2.39~36.99) 0.001 12.04(5.60~25.88) ＜0.001 最近1次吸毒后发生性行为Syringes were shared 否No 1.00 1.00 是Yes 4.61(1.24~17.18) 0.018 1.61(0.73~3.57) 0.311 最近1年与商业性伴发生性行为Sexual activity in the last year 否No 1.00 1.00 是Yes 1.30(0.34~4.95) 0.561 0.96(0.44~1.78) 0.732 梅毒Syphilis 阴性Negative 1.00 1.00 阳性Positive 0.86(0.43~1.78) 0.678 0.89(0.72~1.75) 0.621 注：HCV, 丙型肝炎病毒。
Note：HCV, hepatitis C virus.
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[1] 姚晖, 张思晨, 冯金保, 等. 安徽省强制戒毒人群HIV、HCV和梅毒感染状况及影响因素分析[J]. 中华疾病控制杂志, 2021, 25(12): 1403-1408. DOI: 10.16462/j.cnki.zhjbkz.2021.12.008.Yao H, Zhang SC, Feng JB, et al. Prevalence and influencing factors of HIV, HCV and syphilis among drug addicts in compulsory detoxification center of Anhui Province[J]. Chin J Dis Control Prev, 2021, 25(12): 1403-1408. DOI: 10.16462/j.cnki.zhjbkz.2021.12.008. [2] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2022年版)[J]. 中华肝脏病杂志, 2022, 30(12): 1332-1348. DOI: 10.3760/cma.j.cn501113-20221220-00605.Chinese Society of Hepatology, Chinese Society of Infectious Diseases. Guideline for the prevention and treatment of hepatitis C (2022 version)[J]. Chin J Hepatol, 2022, 30(12): 1332-1348. DOI: 10.3760/cma.j.cn501113-20221220-00605. [3] Bansal S, Singal AK, McGuire BM, et al. Impact of all oral anti-hepatitis C virus therapy: a meta-analysis[J]. World J Hepatol, 2015, 7(5): 806-813. DOI: 10.4254/wjh.v7.i5.806. [4] Schinazi R, Halfon P, Marcellin P, et al. HCV direct-acting antiviral agents: the best interferon-free combinations[J]. Liver Int, 2014, 34(Suppl 1): 69-78. DOI: 10.1111/liv.12423. [5] Marincovich B, Castilla J, del Romero J, et al. Absence of hepatitis C virus transmission in a prospective cohort of heterosexual serodiscordant couples[J]. Sex Transm Infect, 2003, 79(2): 160-162. DOI: 10.1136/sti.79.2.160. [6] Wasley A, Miller JT, Finelli L, et al. Surveillance for acute viral hepatitis: United States, 2005[J]. MMWR Surveill Summ, 2007, 56(3): 1-24. [7] Magder LS, Fix AD, Mikhail NN, et al. Estimation of the risk of transmission of hepatitis C between spouses in Egypt based on seroprevalence data[J]. Int J Epidemiol, 2005, 34(1): 160-165. DOI: 10.1093/ije/dyh370. [8] Wandeler G, Gsponer T, Bregenzer A, et al. Hepatitis C virus infections in the Swiss HIV cohort study: a rapidly evolving epidemic[J]. Clin Infect Dis, 2012, 55(10): 1408-1416. DOI: 10.1093/cid/cis694. [9] Terrault NA, Dodge JL, Murphy EL, et al. Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study[J]. Hepatology, 2013, 57(3): 881-889. DOI: 10.1002/hep.26164. -
