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Injection drug users: The overlooked core of the hepatitis C epidemic

Clinical Infectious Diseases (Impact Factor: 9.42). 04/2006; 42(5):673-6. DOI: 10.1086/499960
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Available from: Brian R Edlin, Jul 31, 2015
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    • ". As already stated, IDU has become the main transmission mechanism of HCV in Western Europe [3] and, along with the explosive increase of IDU in Eastern Europe, has placed drug users (IDUs) at the core of the HCV epidemic [122]. "
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    ABSTRACT: Long-term changes in the frequency and outcome of hepatitis delta virus (HDV) infection have seldom been analysed. This retrospective, longitudinal study includes 398 consecutive hepatitis B surface antigen (HBsAg)-positive patients with anti-HDV antibodies who attended our institution between 1983 and 2008. At enrolment, 182 patients had acute and 216 chronic hepatitis. Patients were grouped into two periods. Those who attended between 1983 and 1995 and those between 1996 and 2008. The former group was significantly younger, mainly intravenous drugs users, and had a greater incidence of acute HDV and HIV and HCV coinfection. Patients with acute HBV/HDV coinfection cleared both infections in 90% of cases, while all patients with HDV superinfection evolved to chronic disease. One hundred and fifty-eight patients with chronic HDV were followed for a median period of 158months. Seventy-two per cent of the patients remained stable, 18% had hepatic decompensation, 3% developed hepatocellular carcinoma, and 8% cleared HBsAg. Liver-related death was observed in 13% of patients and mainly occurred in patients from the first period (P=0.012). These results indicate an outbreak of HDV at the end of the 1980s and the beginning of the 1990s, with a large number of acute HDV cases affecting predominately young, male intravenous drug users. Currently, patients with chronic HDV disease are older, and factors associated with worse prognosis include the presence of cirrhosis and age at the time of diagnosis.
    Journal of Viral Hepatitis 06/2011; 18(6):434-42. DOI:10.1111/j.1365-2893.2010.01324.x · 3.31 Impact Factor
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    • "The incidence of hepatitis C virus (HCV) remains high (16–42% per year) among young injection drug users (IDU)(Edlin and Carden, 2006; Hahn et al., 2002). The rationale for screening populations at risk for HCV includes the possibility of altering risk behaviors that impact disease progression and transmission, but limited research exist to support this hypothesis (Chou et al., 2004). "
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    ABSTRACT: The rationale for screening populations at risk for hepatitis C virus infection (HCV) includes the possibility of altering risk behaviors that impact disease progression and transmission. This study prospectively examined young injection drug users (IDU) to determine if behaviors changed after they were made aware of HCV seroconversion. We estimated the effects of HCV seroconversion coupled with post-test counseling on risk behaviors (alcohol use, non-injection and injection drug use, lending and sharing injecting equipment, and having sex without a condom) and depression symptoms using conditional logistic regression, fitting odds-ratios for immediately after disclosure and 6 and 12 months later, and adjusting for secular effects. 112 participants met inclusion criteria, i.e. they were documented HCV seronegative at study onset and subsequently seroconverted during the follow-up period, with infection confirmed by HCV RNA testing. HCV seroconversion was independently associated with a decreased likelihood of consuming alcohol (OR=0.52; 95% CI: 0.27-1.00, p=0.05) and using non-injection drugs (OR=0.40; 95% CI: 0.20-0.81, p=0.01) immediately after disclosure, however, results were not sustained over time. There were significant (p<0.05) declines in the use of alcohol, injection and non-injection drugs, and sharing equipment associated with time that were independent from the effect of seroconversion. Making young IDU aware of their HCV seroconversion may have a modest effect on alcohol and non-injection drug use that is not sustained over time.
    Drug and alcohol dependence 07/2009; 105(1-2):160-3. DOI:10.1016/j.drugalcdep.2009.05.022 · 3.28 Impact Factor
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    • ". As already stated, IDU has become the main transmission mechanism of HCV in Western Europe [3] and, along with the explosive increase of IDU in Eastern Europe, has placed drug users (IDUs) at the core of the HCV epidemic [122]. "
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    ABSTRACT: The epidemic of hepatitis C virus (HCV) infection in Europe is continuously evolving and epidemiological parameters (prevalence, incidence, disease transmission patterns and genotype distribution) have changed substantially during the last 15 years. Four main factors contribute to such changes: increased blood transfusion safety, improvement of healthcare conditions, continuous expansion of intravenous drug use and immigration to Europe from endemic areas. As a result, intravenous drug use has become the main risk factor for HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Hence, prevalence data from studies conducted a decade ago may not be useful to estimate the current and future burden of HCV infection and additional epidemiological studies should be conducted, as well as new preventive strategies implemented to control the silent epidemic. This review summarizes recently published data on the epidemiology of HCV infection in Europe focusing on the factors currently shaping the epidemic.
    Journal of Hepatology 02/2008; 48(1):148-62. DOI:10.1016/j.jhep.2007.07.033 · 10.40 Impact Factor
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