Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C and hepatitis B:Results from the Global Burden of Disease GBD 2013 study

摘要

Background: Previous estimates of the burden of HIV, hepatitis B (HBV) and hepatitis C (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We provided these estimates in the Global Burden of Disease (GBD) 2013 study. Methods: We modelled HBV and HCV burden (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted data on the proportion of notified HIV cases by transmission route and estimated the contribution of IDU to HBV and HCV disease burden using a cohort method that injecting drug use (IDU) to HBV and HCV disease burden using a cohort method that recalibrated individuals’ history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injectors; and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through three metrics: years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability-adjusted life-years (DALYs).Findings: In 2013, an estimated 10.08 million DALYs were attributable to previous exposure to HIV, HBV and HCV via IDU, a four-fold increase since 1990. In 2013, IDU was estimated to cause 4.0% (2.82 million DALYs (95% uncertainty interval (95%UI) 2.4-3.8 million DALYs), 1.1% (216,000; 101,000-338,000) and 39.1% (7.05 million; 5.88-8.15 million) of total DALYs due to HIV, HBV and HCV, respectively. IDU-attributable HCV burden was 2.5 times that for HIV. IDU-attributable HIV burden was highest in low- to middle-income countries, and IDU-attributable HCV burden highest in high-income countries.Conclusions: IDU is a major contributor to GBD. There is a need to scale up efficacious interventions to prevent and treat these important causes of health burden.