Article

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

ABSTRACT

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

Full-text

Available from: Steffanie A Strathdee
  • Source
    • "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: Within the Dutch Acute HCV in HIV Study, a surveillance system was initiated to estimate the incidence of hepatitis C virus (HCV) infections in 2014. Following the Dutch HIV treatment guidelines, HIV-positive men having sex with men (MSM) in 19 participating centers were screened. Ninety-nine acute HCV infections were reported, which resulted in a mean incidence of 11 per 1000 patient-years of follow-up. Unfortunately, the HCV epidemic among Dutch HIV-positive MSM is not coming to a halt. © 2015 European Society of Clinical Microbiology and Infectious Diseases.
    Full-text · Article · Oct 2015 · Clinical Microbiology and Infection
  • 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.
    Full-text · Article · Apr 2015 · International Journal of Drug Policy
    • "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.
    No preview · Article · Apr 2015 · Clinical Microbiology and Infection
Show more