Syringe Exchange and Risk of Infection with Hepatitis B and C Viruses

Seattle-King County Department of Public Health HIV/AIDS Epidemiology Unit, MA 98104, USA.
American Journal of Epidemiology (Impact Factor: 5.23). 03/1999; 149(3):203-13. DOI: 10.1093/oxfordjournals.aje.a009792
Source: PubMed


The authors utilized a cohort study among Seattle injection drug users (IDUs) to assess whether participation in a syringe exchange program was associated with incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Susceptible IDU subjects (187 seronegative for antibody to HCV, and 460 seronegative for core antibody to HBV) were identified in drug treatment, corrections, and social service agencies from June 1994 to January 1996, and followed for seroconversion one year later. The subjects included in the analysis were Seattle-King County (Washington State) area IDUs enrolled in a larger multipurpose cohort study, the Risk Activity Variables, Epidemiology, and Network Study (RAVEN Study). There were 39 HCV infections (20.9/100/year) and 46 HBV infections (10.0/100/year). There was no apparent protective effect of syringe exchange against HBV (former exchange users, relative risk (RR) = 0.68, 95% confidence interval (CI) 0.2-2.5; sporadic exchange users, RR = 2.4, 95% CI 0.9-6.5; regular users, RR = 1.81, 95% CI 0.7-4.8; vs. RR = 1.0 for nonusers of the exchange; adjusted for daily drug injection). Neither did the exchange protect against HCV infection (sporadic users, RR = 2.6, 95% CI 0.8-8.5; regular users, RR = 1.3, 95% CI 0.8-2.2; vs. RR = 1.0 for nonusers; adjusted for recent onset of injection and syringe sharing prior to enrollment). While it is possible that uncontrolled confounding or other bias obscured a true beneficial impact of exchange use, these data suggest that no such benefit occurred during the period of the study.

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    • "Many injection drug users continue to have limited access to sterile syringes, continue to reuse and share injection equipment (Wood et al., 2002), and engage in high risk sexual behavior. Syringe exchanges may not protect against hepatitis (B and C) infection (Hagan et al., 1999); although a more recent systematic review and meta-analysis reported protective effects (Hagan, Pouget, & Des Jarlais, 2011). Because of uneven progress toward suppressing HIV and hepatitis C infection, advocates promote more aggressive risk reduction interventions including " safer injection sites " for PWID. "
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