Attribution of Hepatitis C Virus Seroconversion Risk in Young Injection Drug Users in 5 US Cities

College of Nursing, New York University, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 02/2010; 201(3):378-85. DOI: 10.1086/649783
Source: PubMed


BACKGROUND. In studies of hepatitis C virus (HCV) seroconversion in injection drug users (IDUs), some have questioned whether underreporting of syringe sharing, a stigmatized behavior, has led to misattribution of HCV risk to other injection-related behaviors. METHODS. IDUs aged 15-30 years who were seronegative for human immunodeficiency virus and HCV antibodies were recruited into a prospective study in 5 US cities. Behavioral data were collected via computer-assisted self-interviewing to reduce socially desirable reporting. Hazard ratios (HRs) were estimated to assess associations between behavior and HCV seroconversion. Because the shared use of cookers, cottons, and rinse water was highly correlated, a summary variable was created to represent drug preparation equipment sharing. RESULTS. Among 483 IDUs who injected during the period covered by the follow-up assessments, the incidence of HCV infection was 17.2 cases per 100 person years; no HIV seroconversions occurred. Adjusting for confounders, the shared use of drug preparation equipment was significantly associated with HCV seroconversion (adjusted HR, 2.66; 95% confidence interval, 1.03-23.92), but syringe sharing was not (adjusted HR, 0.91). We estimated that 37% of HCV seroconversions in IDUs were due to the sharing of drug preparation equipment. CONCLUSIONS. Associations between sharing drug preparation equipment and HCV seroconversion are not attributable to underascertainment of syringe sharing. Avoiding HCV infection will require substantial reductions in exposure to all sources of contaminated blood.

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Available from: Steffanie A Strathdee, Jan 07, 2014
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    • "sharing of contaminated needles/syringes and ancillary drug injecting equipment (Hagan et al., 2010; Nelson et al., 2011; Thorpe et al., 2002). Many structural and social constraints impact access to sterile injecting equipment, resulting in injection equipment sharing rates between 30-70% among people who inject drugs (PWID; Bruneau et al., 2008; Munoz et al., 2014; Pouget et al., 2012). "
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    ABSTRACT: Background: Studies have shown intimate injection partners engage in higher rates of syringe and injecting equipment sharing. We examined the drug use context and development of injection drug use behaviors within intimate injection partnerships. Methods: In-depth interviews (n=18) were conducted with both members of nine injecting partnerships in Sydney, Australia. Content analysis identified key domains related to the reasons for injecting with a primary injection partner and development of drug injection patterns. Main findings: Most partnerships (n=5) were also sexual; three were blood-relatives and one a friend dyad. The main drug injected was heroin (66%) with high rates of recent sharing behaviors (88%) reported within dyads. Injecting within a primary injection partnership provided perceived protection against overdose events, helped reduce stress, increased control over when, where, and how drugs were used, and promoted the development of an injecting pattern where responsibilities could be shared. Unique to injecting within primary injection partnerships was the social connection and companionship resulted in a feeling of fulfillment while also blinding one from recognizing risky behavior. Conclusions: Findings illuminated the tension between protection and risks within primary injection partnerships. Primary injection partnerships provide a potential platform to expand risk reduction strategies.
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    • "This could be due to the significant proportion of inmates with a history of IDU who continue high-risk activities related to drug injection [47]. These high-risk activities have also been described in other geographical regions [16], [18], [45], [48] and among IDU patients [15], [16], [18] It has been suggested that better access to sterile needles is needed and target groups should include inmates who inject drugs [42]. "
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    Full-text · Article · Feb 2014 · PLoS ONE
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    • "Although similar in some ways, the practices that contribute to bacterial infections are somewhat distinct from those that lead to viral infection. The transmission of blood via shared needles, syringes, cottons, and water contributes to HIV and HCV acquisition (Chitwood et al., 1995; Hagan et al., 2001, 2010; Patrick et al., 1997; Strathdee et al., 2001). Although IDUs can pass bacterial infections to each other via shared equipment (Gordon & Lowy, 2005), other factors may be more important. "
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