Changes in Blood-borne Infection Risk Among Injection Drug Users

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 03/2011; 203(5):587-94. DOI: 10.1093/infdis/jiq112
Source: PubMed


Population-level hepatitis C virus (HCV) infection incidence is a surrogate for community drug-related risk.
We characterized trends in human immunodeficiency virus (HIV) and HCV infection incidence and HCV infection prevalence among injection drug users (IDUs) recruited over 4 periods: 1988-1989, 1994-1995, 1998, and 2005-2008. We calculated HIV and HCV infection incidence within the first year of follow-up among IDUs whose test results were negative for these viruses at baseline (n = 2061 and n = 373, respectively). We used Poisson regression to compare trends across groups.
HIV infection incidence declined significantly from 5.5 cases/100 person-years (py) in the 1988-1989 group to 2.0 cases/100 py in the 1994-1995 group to 0 cases/100 py in the 1998 and 2005-2008 groups. Concurrently, HCV infection incidence declined but remained robust (22.0 cases/100 py in the 1988-1989 cohort to 17.2 cases/100 py in the 1994-1995 cohort, 17.9 cases/100 py in the 1998 cohort, and 7.8 cases/100 py in the 2005-2008 cohort; P = .07). Likewise, HCV infection prevalence declined, but chiefly in younger IDUs. For persons aged <39 years, relative to the 1988-1989 cohort, all groups exhibited significant declines (adjusted prevalence ratio [PR] for the 2005-08 cohort, .73; 95% confidence interval [CI], .65-.81). However, for persons aged ≥ 39 years, only the 2005-2008 cohort exhibited declining prevalence compared with the 1988-1989 cohort (adjusted PR, .87; 95% CI, .77-.99).
Although efforts to reduce blood-borne infection incidence have had impact, this work will need to be intensified for the most transmissible viruses, such as HCV.

Download full-text


Available from: Steffanie A Strathdee,
  • Source
    • "David C. Perlman 1 , Ashly E. Jordan 2 , Anneli Uuskula 3 , Duong Thi Huong 4 , Carmen L. Masson 5 , Bruce R. Schackman 6 , Don C. Des Jarlais Li, Jalaludin, Chant, & Kaldor, 2007; Mehta, et al., 2011; Wiessing, et al., 2014 "
    [Show abstract] [Hide abstract]
    ABSTRACT: People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries-the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include (1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, (2) inconsistent use of OST as a platform for HCV services, (3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and (4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: (1) maintaining current HIV prevention efforts, (2) expanding efforts to reduce the stigmatization of drug use, (3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, (4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV. Copyright © 2015 Elsevier B.V. All rights reserved.
    International Journal of Drug Policy 04/2015; 26(11). DOI:10.1016/j.drugpo.2015.04.015 · 2.40 Impact Factor
    • "Most implemented interventions are opiate substitution and needle exchange programmes, for which high coverage of combined programmes is associated with a reduction in the incidence of acute HCV infection [10] [11]. However, the incidence of HCV infection within IDUs does not seem to decline to the very low levels that have been observed for HIV [12]. This difference might be atributable to the virological characteristics of the virus, as HCV is approximately ten times more likely to be transmitted through a needle puncture than HIV [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute hepatitis C virus (AHCV) infections are frequently seen worldwide in certain risk groups with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Current used methods to diagnose AHCV are IgG antibody seroconversion and repeated HCV RNA measurements though no definite diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided to both advancements in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV will affect therapeutic regimens in AHCV in the coming years leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties together with some future perspectives on acute HCV epidemiology, virology, immunology and treatment. Copyright © 2015. Published by Elsevier Ltd.
    Clinical Microbiology and Infection 04/2015; 21(8). DOI:10.1016/j.cmi.2015.03.026 · 5.77 Impact Factor
  • Source
    • "Previous studies support this finding that younger users were more likely to share syringes and use syringes used by someone else (Fennema et al., 1997; Novelli et al., 2005). It is worth noting that this risk behavior can increase a person's risk of contracting HIV significantly and should not be discounted (Mehta et al., 2011). More education and counseling should be provided among the younger IDU population (less than 21 years old) to reduce the risk of HIV (Solomon et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Injecting drug use accounts for 10% of new HIV cases worldwide. Younger injecting drug users are more likely to engage in HIV risk behaviors. Objectives: To assess the association between the age at initiation of injecting drugs and HIV risk behaviors. Methods: Houston data from the National HIV Behavioral Surveillance System were analyzed. The primary exposure variable was the self-reported age at injecting drug initiation. This study assessed whether individuals who initiated injecting drugs before and after the age of 21 differ by selected socio-demographic characteristics and high risk behaviors. Results: Black race and lower education level were shown to be the only statistically significant factors with those self-reported to initiate injecting drugs before turning 21. The group initiating use before the age of 21 was found to be more likely to share needles. Conclusions: This study highlights that race and education are positively associated with younger injecting drug initiation and younger injectors tend to engage in HIV risk behaviors such as needle sharing.
    Journal of Substance Use 07/2013; 19(4). DOI:10.3109/14659891.2013.804604 · 0.48 Impact Factor
Show more