Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment
ABSTRACT 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.
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ABSTRACT: Background: Methadone maintenance treatment (MMT) has rapidly expanded in China, from 8 pilot sites to 696 clinics covering 27 provinces, during 2004-2010. This study evaluates the demographic characteristics and drug use behaviors associated with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infections among MMT entrants through a systematic review and meta-analysis of published literature. Methods: Thirty-nine eligible articles (1 in English and 38 in Chinese) were selected for this review. We extracted the relevant indicator information from all eligible studies and performed meta-analyses, by stratifying according to sex of the participants, age groups and drug use behaviors. Five provinces (i.e., Yunnan, Guizhou, Sichuan, Guangxi and Xinjiang) with the population size of HIV-infected drug users greater than 10,000 were defined as high transmission areas (HTAs) for HIV infection; whereas the remaining twenty-six Chinese provinces were considered as low transmission areas (LTAs). Results: The odds of being infected by HIV among male drug users were significantly higher than for females in high transmission areas (OR=1.49, 95% CI: 1.11-1.99, k=9), while the opposite results were observed in low transmission areas (OR=0.46, 0.27-0.79, k=11). In comparison, no significant differences in risk behaviors were found between sexes in HTAs and LTAs. Younger age was not associated with risk of HIV infection, but was associated with higher risk of HCV infection (<30 years OR=1.88; 30-40 years OR=2.21, compared with >40 years, k=17). Risk of HIV infection was higher among injectors than non-injectors (OR=4.29, 2.70-6.79, k=14) and for those who inject, there was greater risk among sharers than non-sharers (OR=2.47, 1.44-4.23, k=4). Similar patterns were also observed in HCV infection (injectors: OR=10.82, 7.60-15.40; sharers: OR=3.41, 2.56-4.54, k=7). Conclusions: Characteristics of MMT entrants positive for HIV or HCV in China vary by disease types, geographical region, sex, age, and injecting behavior. These factors need to be considered in targeted interventions for MMT participants, such as age-specific health education and psychological treatment, antiretroviral therapy and needle-syringe exchange programs.Drug and alcohol dependence 06/2012; 126(3). DOI:10.1016/j.drugalcdep.2012.05.028 · 3.28 Impact Factor
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ABSTRACT: High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population. The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations. Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race. Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.BMC Public Health 12/2010; 10:777. DOI:10.1186/1471-2458-10-777 · 2.32 Impact Factor
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ABSTRACT: People who inject drugs (PWID) are at high risk of HCV. Limited evidence of the effectiveness of prevention interventions and low uptake of treatment in this group highlight the need for increased investment in biomedical interventions, notably safe and efficacious vaccines. While several candidates are currently in development, field trials in PWID present challenges, including ethical issues associated with trial literacy, informed consent and standards of care. Significant biological and social factors and differences between HIV and HCV suggest that HCV warrants targeted vaccine preparedness research to lay the groundwork for successful implementation of future trials.Vaccine 10/2010; 28(45):7273-8. DOI:10.1016/j.vaccine.2010.08.085 · 3.49 Impact Factor