Article

Injection Drug Users: The Overlooked Core of the Hepatitis C Epidemic

Clinical Infectious Diseases (Impact Factor: 8.89). 04/2006; 42(5):673-6. DOI: 10.1086/499960
Source: PubMed
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Available from: Brian R Edlin
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    • "Because HCV is a blood-borne pathogen and injection drug use is a primary mode of its transmission in developed countries, HCV infection prevalence among persons who inject drugs (PWID) reaches as high as 80%, whereas the annual incidence ranges from 16% to 42% (Edlin and Carden, 2006; Amon et al., 2008; Nelson et al., 2011). Despite high prevalence , however, participation of PWID in HCV-related care has been extremely low (Mehta et al., 2008). "

    Full-text · Article · Nov 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.
    Full-text · Article · Jun 2011 · Journal of Viral Hepatitis
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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.
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