Article

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: 4.98). 03/1999; 149(3):203-13. DOI: 10.1093/oxfordjournals.aje.a009792
Source: PubMed

ABSTRACT 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.

Download full-text

Full-text

Available from: Hanne Thiede, Jul 26, 2015
0 Followers
 · 
130 Views
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    American Psychologist 01/2013; 68(4):274-285. DOI:10.1037/a0032745 · 6.87 Impact Factor
  • Source
    • "Ȥ 2 < 0.001 16.54 11.71, 21.37 I 2 = 99.9, Ȥ 2 < 0.001 11.69 7.93, 15.44 0.00 20.00 40.00 60.00 macalino, 2004 khan, 2005 levine, 1996 des jarlais, 2003 des jarlais, 2003 hagan, 1999 "
    [Show abstract] [Hide abstract]
    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(1):777. DOI:10.1186/1471-2458-10-777 · 2.32 Impact Factor
  • Source
    • "A longitudinal study of Italian IDUs found evidence of significant clinical protection among those who had received at least three doses of the vaccine, despite the fact that only 72% had serological evidence of protective anti-HBs levels (Lugoboni et al., 2004). High rates of hepatitis C virus (HCV) infection in this population (Hagan et al., 1999; Hahn et al., 2002; Judd et al., 2005; Maher et al., 2006; Miller et al., 2002) make prevention particularly important because of the increased morbidity associated with HBV/HCV co-infection (Amin, Law, Bartlett, Kaldor, & Dore, 2006). "
    The International journal on drug policy 03/2008; 19(6):425-8. DOI:10.1016/j.drugpo.2007.12.010 · 2.54 Impact Factor
Show more

Similar Publications