Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections

Abstract

BackgroundInjection drug use provides an efficient mechanism for transmitting bloodborne viruses, including human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Effective targeting of resources for prevention of HIV and HCV infection among persons who inject drugs (PWID) is based on knowledge of the population size and disparity in disease burden among PWID. This study estimated the number of PWID in the United States to calculate rates of HIV and HCV infection.MethodsWe conducted meta-analysis using data from 4 national probability surveys that measured lifetime (3 surveys) or past-year (3 surveys) injection drug use to estimate the proportion of the United States population that has injected drugs. We then applied these proportions to census data to produce population size estimates. To estimate the disease burden among PWID by calculating rates of disease we used lifetime population size estimates of PWID as denominators and estimates of HIV and HCV infection from national HIV surveillance and survey data, respectively, as numerators. We calculated rates of HIV among PWID by gender-, age-, and race/ethnicity.ResultsLifetime PWID comprised 2.6% (95% confidence interval: 1.8%–3.3%) of the U.S. population aged 13 years or older, representing approximately 6,612,488 PWID (range: 4,583,188–8,641,788) in 2011. The population estimate of past-year PWID was 0.30% (95% confidence interval: 0.19 %–0.41%) or 774,434 PWID (range: 494,605–1,054,263). Among lifetime PWID, the 2011 HIV diagnosis rate was 55 per 100,000 PWID; the rate of persons living with a diagnosis of HIV infection in 2010 was 2,147 per 100,000 PWID; and the 2011 HCV infection rate was 43,126 per 100,000 PWID.ConclusionEstimates of the number of PWID and disease rates among PWID are important for program planning and addressing health inequities.

Population Size Estimates for Men who Have Sex with Men and Persons who Inject Drugs

“…Therefore, these data are not directly comparable to estimates that use behavior in the past 5 years 2,8 . However, we believe that the past 12 month estimates are appropriate for identifying populations who continue to be at risk of HIV acquisition.…”

“…[6][7][8] These estimates are extremely useful for studies that are nationwide or are conducted in specific metropolitan areas, but they do not allow for aggregation of data across sub-national areas that also contain small cities or nonmetropolitan areas. We are not aware of published estimates of the overall prevalence of injection drug use by urbanicity, although estimates for prevalence of injection drug use by region and estimates for injection of specific drugs by urbanicity have been published.…”

Preoperative evaluation for coronary atherosclerosis with computed tomography angiography in intravenous drug users: an emerging indication in the face of a growing threat

“…Given the recent rise in IDU and increasing incidence of endocarditis, we anticipate a rise in necessity for imaging these patients [2,3]. Our retrospective cohort demonstrates the successful use of CCTA instead of invasive coronary angiography (ICA) in most patients with prior history of IDU to evaluate for coronary artery disease.…”

“…More than 6 million people in the United States have a history of intravenous injection drug use (IDU), of these, 1 million are active IDU according to the Centers for Disease Control [1,2]. Numerous illicit drugs can be injected intravenously, with heroin, cocaine, and methamphetamines being the most common.…”

Reimagining long‐term antibiotics in persons who inject drugs: Time to shift the status quo?

“…1 The practice of IDU predisposes individuals to serious bacterial and fungal infections that often require long-term intravenous antibiotics. In individuals without IDU, these serious infections are often treated with outpatient parenteral antibiotic therapy (OPAT).…”