Non-injection drug use and Hepatitis C Virus: A systematic review

Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Drug and Alcohol Dependence (Impact Factor: 3.42). 07/2007; 89(1):1-12. DOI: 10.1016/j.drugalcdep.2006.11.014
Source: PubMed


This systematic review examined the evidence on the prevalence of the Hepatitis C Virus (HCV) in non-injecting drug users (NIDUs) who sniff, smoke or snort drugs such as heroin, cocaine, crack or methamphetamine. The search included studies published from January 1989 to January 2006. Twenty-eight eligible studies were identified and the prevalence of HCV in these NIDU populations ranged from 2.3 to 35.3%. There was substantial variation in study focus and in the quality of the NIDU data presented in the studies. The results of our systematic review suggested that there are important gaps in the research of HCV in NIDUs. We identified a problem of study focus; much of the research did not aim to study HCV in users of non-injection drugs. Instead, NIDUs were typically included as a secondary research concern, with a principal focus on the problem of transmission of HCV in IDU populations. Despite methodological issues, HCV prevalence in this population is much higher than in a non-drug using population, even though some IDUs might have inadvertently been included in the NIDU samples. These studies point to a real problem of HCV in NIDU populations, but the causal pathway to infection remains unclear.

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Available from: Don C Des Jarlais, Feb 20, 2014
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    • "People who smoke crack experience disproportionately high levels of morbidity, such as chronic and infectious diseases, physical health problems, and mental health challenges (Falck et al., 2004; Fischer & Coghlan, 2007), even in comparison to other drug-using populations (Fischer et al., 2006). Crack smoking is independently associated with HIV and hepatitis C (HCV) infection (DeBeck et al., 2009; Roy et al., 2001), and the incidence of HIV and HCV among crack-smoking populations has been documented to be as high as 7.5% and 35.3%, respectively (Kral et al., 1998; Scheinmann et al., 2007). Crack-smoking populations are also severely socially marginalized, and disproportionately impacted by intersecting social inequities that function to increase their exposure to violence and compromise their health (Bungay, Johnson, Varcoe, & Boyd, 2010; Fischer & Coghlan, 2007). "
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    ABSTRACT: Introduction: Many cities around the globe have experienced substantial increases in crack cocaine use. Public health programmes have begun to address crack smoking, primarily through the distribution of safer crack use equipment, but their impacts have been limited. More comprehensive safer environmental interventions, specifically safer smoking rooms (SSR), have been implemented only in select European cities. However, none have been subjected to rigorous evaluation. This ethnographic study was undertaken at an 'unsanctioned' SSR operated by a drug user-led organization in Vancouver, Canada, to explore how this intervention shaped crack smoking practices, public crack smoking, and related harms. Methods: Ethnographic fieldwork was undertaken at this SSR from September to December 2011, and included approximately 50 hours of ethnographic observation and 23 in-depth interviews with people who smoke crack. Data were analyzed by drawing on the 'Risk Environment' framework and concepts of 'symbolic', 'everyday', and 'structural' violence. Findings: Our findings illustrate how a high demand for SSRs was driven by the need to minimize exposure to policing (structural violence), drug scene violence (everyday violence), and stigma (symbolic violence) that characterized unregulated drug use settings (e.g., public spaces). Although resource scarcity and social norms operating within the local drug scene (e.g., gendered power relations) perpetuated crack pipe-sharing within unregulated drug use settings, the SSR fostered harm reduction practices by reshaping the social-structural context of crack smoking and reduced the potential for health harms. Conclusion: Given the significant potential of SSRs in reducing health and social harms, there is an urgent need to scale up these interventions. Integrating SSRs into public health systems, and supplementing these interventions with health and social supports, has potential to improve the health and safety of crack-smoking populations.
    Full-text · Article · Jan 2015 · International Journal of Drug Policy
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    • "HCV infection related to drug use has been addressed in several previous systematic reviews. These have covered HCV epidemiology in people who smoke or inhale drugs such as heroin, cocaine or crack [20], HCV epidemiology in people who inject drugs (PWID) [21,22], prevention and treatment of HCV infection in PWID [23-26], and heterosexual HCV transmission [27]. We are aware of only one systematic review describing HCV incidence in HIV-positive MSM; this review included 12 eligible articles [28]. "
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    ABSTRACT: Outbreaks of hepatitis C virus (HCV) infection have been reported in HIV-positive men who have sex with men (MSM) in North America, Europe and Asia. Transmission is believed to be the result of exposure to blood during sexual contact. In those infected with HIV, acute HCV infection is more likely to become chronic, treatment for both HIV and HCV is more complicated and HCV disease progression may be accelerated. There is a need for systematic reviews and meta-analyses to synthesize the epidemiology, prevention and methods to control HCV infection in this population.Methods/design: Eligible studies will include quantitative empirical data related to sexual transmission of HCV in HIV-positive MSM, including data describing incidence or prevalence, and associations between risk factors or interventions and the occurrence or progression of HCV disease. Care will be taken to ensure that HCV transmission related to injection drug use is excluded from the incidence estimates. Scientific databases will be searched using a comprehensive search strategy. Proceedings of scientific conferences, reference lists and personal files will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle-Ottawa scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis. HIV-positive MSM are a key HCV-affected population in the US and other high-income countries. This review seeks to identify modifiable risk factors and settings that will be the target of interventions, and will consider how to constitute a portfolio of interventions to deliver the greatest health benefit. This question must be considered in relation to the magnitude of HCV infection and its consequences in other key affected populations, namely, young prescription opioid users who have transitioned to illicit opiate injection, and older injection drug users among whom HCV prevalence and incidence are extremely high. This review is part of a series of systematic reviews and meta-analyses that will synthesize the evidence across all these population groups and develop recommendations and decision tools to guide public health resource allocation.Trial registration: PROSPERO registration number: CRD42013006462.
    Full-text · Article · Mar 2014 · Systematic Reviews
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    • "It is estimated that more than 60% of the new cases of HCV infection recorded each year are related to the use of illicit drugs, especially by injection [1]. The prevalence of HCV infection in illicit drug users varies from 10% to 95%, reflecting the presence or absence of specific risk factors, such as the history of drug use, sharing of drug paraphernalia (needles, syringes, pipes, cans, and so on), the number of partners present during shared use, detention and the use of drugs in jail or prison, and the type of consumption: inhaled or injected [2,3]. A number of studies have shown that the sharing of drug paraphernalia is responsible for the spread of HCV among both injecting drug users and non-injecting drug users [2,4-6]. "
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    ABSTRACT: Currently, sharing of drug paraphernalia is the main form of HCV transmission worldwide. In South America, consistent findings indicate that shared sniffing equipment is an important factor in the spread of HCV among non-injecting drug users. Epidemiological data on the status of HCV infection in illicit drug users in the Amazon region are scarce, although reports of clinical cases of hepatitis or pathologies associated with HCV infection in other population groups are numerous. Thereby, this study investigated the prevalence, genotype frequency, and epidemiological factors associated with HCV infection in non-injecting drug users in the state of Para, eastern Amazon. During 2008-2011, 300 non-injecting drug users attending drug-treatment centers participated in this study. Most non-injecting drug users were male (63.7%). The mean age was 32.5 years. The non-injecting drugs most consumed were: cannabis (15.6%), cocaine paste (21.3%), and oxi cocaine (25.7%). Tobacco (60.9%) and alcohol (79.4%) were also commonly consumed. One hundred six (35.1%; CI 95%: 29.8 - 41.1) non-injecting drug users presented anti-HCV antibodies by EIA. The HCV-RNA prevalence was 28.0% (95% CI: 20.6 - 35.8). Genotypes 1 (76.9%) and 3 (23.1%) of HCV have been identified. A multivariate analysis demonstrated that HCV infection was independently associated with the following factors: "age (>= 35 years)", "tattoos", "use of a needle or syringe sterilized at home", "shared use of drug paraphernalia", "uses drugs for more than 5 years", and "use of drugs everyday". This study revealed a high prevalence of HCV infection in non-injecting drug users, and most infections are occasioned by genotype 1. Likely, HCV transmission is associated with the tattoos, the use of needle or syringe sterilized at home by people over the age of 35 years, and sharing, time and frequency of use of non-injecting drugs. These findings should serve as an incentive for the establishment of a program of Hepatitis C prevention and control by the local public-health authorities in order to develop effective policies and strategies for contain the spread of HCV infection.
    Full-text · Article · Feb 2014 · Virology Journal
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