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.
"Treating 8%–15% of HCV-infected active PWIDs annually for HCV would reduce HCV prevalence by 75% over 15 years according to a conservative model that assumed that reinfection rates post-treatment were the same as initial infection rates.46 Cohort studies, however, estimate the reinfection rate at 4%–6% per year,2,47 which is about half the rate assumed for initial infection,48 and those trained in safer injection practices may have even less risk of reinfection. Interferon-free therapies may, if widely available, prove viable for mass treatment of active PWIDs. "
[Show abstract][Hide abstract] ABSTRACT: The US faces at least two distinct epidemics of hepatitis C virus infection (HCV), and due largely to revised screening recommendations and novel therapeutic agents, corresponding opportunities. As only 49%-75% of HCV-infected persons in the US are aware of their infection, any chance of addressing HCV in the US is dependent upon screening to identify undiagnosed infections. Most HCV in the US consists of longstanding infections among persons born during 1945-1965 who are suffering escalating rates of liver-related morbidity and mortality. Mathematical modeling supports aggressive action to reach and treat these persons to minimize the subsequent burden of advanced liver disease on patients and the health care system. Incident infection is primarily among persons who inject drugs, less than 10% of whom have been treated for HCV. Expanded screening and treatment of active persons who inject drugs raises the prospect of utilizing "treatment as prevention" to stem the tide of incident HCV infections in this population. HIV-positive men who have sex with men (MSM) represent a population at risk for sexually transmitted HCV who may also benefit from adjusted screening guidelines to identify both acute and chronic infections. Prisoners also represent a critical population for aggressive screening and treatment. Finally, the two-stage testing algorithm for HCV diagnosis is problematic and difficult for patients and providers to navigate. While emerging therapeutics raise the prospect of reducing HCV-related morbidity and mortality, as well as eliminating new infections, major barriers remain with regard to identifying infections, improving access to treatment, and ensuring payer coverage of costly new therapeutic regimens.
Hepatic Medicine: Evidence and Research 07/2014; 6:79-87. DOI:10.2147/HMER.S40940
"In the U.S., there is growing concern about an emergent HCV epidemic in young adult PWID, not only in urban, but suburban and rural areas
, and reflected by disproportionate increases in the number of acute HCV cases identified among young PWID and reported to the CDC in the past five years
. Our population is comparable to other studies of young adult PWID sampled in urban areas and in national surveys
[17,25,53-56]. The large number of participants who were unstably housed or homeless presents another significant concern and potential opportunity for the implementation of this test. "
[Show abstract][Hide abstract] ABSTRACT: Background
People who inject drugs (PWID) are at highest risk for hepatitis C virus (HCV) infection, yet many remain unaware of their infection status. New anti-HCV rapid testing has high potential to impact this.
Young adult (<30 years) active PWID were offered either the rapid OraQuick® or standard anti-HCV test involving phlebotomy, then asked to complete a short questionnaire about testing perceptions and preferences. Sample characteristics, service utilization, and injection risk exposures are assessed with the HCV testing choice as the outcome, testing preferences, and reasons for preference.
Of 129 participants: 82.9% (n = 107) chose the rapid test. There were no significant differences between those who chose rapid vs. standard testing. A majority (60.2%) chose the rapid test for quick results; most (60.9%) felt the rapid test was accurate, and less painful (53.3%) than the tests involving venipuncture.
OraQuick® anti-HCV rapid test was widely accepted among young PWID. Our results substantiate the valuable potential of anti-HCV rapid testing for HCV screening in this high risk population.
BMC Public Health 06/2014; 14(1):645. DOI:10.1186/1471-2458-14-645 · 2.26 Impact Factor
"The virus is primarily transmitted through blood and blood-related products, and HCV infection is most prevalent among intravenous drug users (IDUs) in developed countries. The mode of HCV transmission among IDUs varies; needles, pipes for snorting, rubber plugs, and cotton swabs are intermediates for infection (2, 3). HCV is the most common cause for liver transplantation in the United States (US Department of Health and Human Services). "
[Show abstract][Hide abstract] ABSTRACT: Epidemiology and transmission patterns of hepatitis C virus (HCV) are important subjects as we enter a new era of treatment with directly acting antivirals (DAAs). The highest prevalence of HCV in developed countries is found among intravenous drug users (IDUs), where unsafe needle sharing practices provide the main route of infection. Efforts to prohibit the continuous spread of HCV among these groups have been initiated by the community services and health care providers. Our goal was to understand how HCV was transmitted among IDUs within a limited population group. We provide a retrospective study (2005-2007) of the HCV transmission patterns in a population of IDUs in the Uppsala region of Sweden.
Eighty-two serum samples were collected from IDUs in Uppsala County. Our reverse transcription nested polymerase chain reaction (RT-nested PCR) and sequencing method enabled a comprehensive genetic analysis for a broad spectrum of genotypes of two relatively conserved regions, NS5B and NS3, that encodes for the viral polymerase and protease, respectively. HCV RNA in serum samples was amplified and sequenced with in-house primers. Sequence similarities between individuals and subgroups were analyzed with maximum likelihood (ML) phylogenetic trees. Published HCV reference sequences from other geographic regions and countries were also included for clarity.
Phylogenetic analysis was possible for 59 NS5B (72%) and 29 NS3 (35%) sequences from Uppsala patients. Additionally, we also included 15 NS3 sequences from Örebro patients, making a total of 44 NS3 sequences for the analysis. By analyzing the NS3 sequences, two transmission sets were found between the IDUs (>98% sequence identity), with one set consisting of two individuals and another set consisting of three individuals. In addition, the phylogenetic analysis done with our serum samples displayed clusters that distinguished them from the reference sequences.
Our method seems to enable us to trace the HCV transmission between IDUs. Furthermore, the method is fairly independent of the time of infection because the method uses relatively conserved HCV sequence regions (i.e. NS5B and NS3).
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