Dead space in over-the-counter syringes: The implications for HIV and HCV transmission

Oramasionwu, Christine U.; Bailey, Stacy Cooper; Moore, Heather; Oramasionwu, Christopher O.; Russell, Allison L.; Zule, William

doi:10.1016/j.drugpo.2015.08.002

Cited by 8 publications

(8 citation statements)

References 13 publications

(23 reference statements)

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“…Our approach used empirical data generated in a set of experiments designed to assess RNA carry-over from an infected syringe donor to an uninfected individual (Figs 2 and 3). Our RNA carry-over data were consistent with prior studies on syringe dead space (15, 26). The average difference in dead space between low and high dead space syringes has been estimated as 10-fold (27).…”

Section: Discussionsupporting

confidence: 89%

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Modeling of patient virus titers suggests that availability of a vaccine could reduce hepatitis C virus transmission among injecting drug users

et al. 2018

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The major route of hepatitis C virus (HCV) transmission in the United States is injection drug use. We hypothesized that if an HCV vaccine were available, vaccination could affect HCV transmission among people who inject drugs by reducing HCV titers after viral exposure without necessarily achieving sterilizing immunity. To investigate this possibility, we developed a mathematical model to determine transmission probabilities relative to the HCV RNA titers of needle/syringe-sharing donors. We simulated sharing of two types of syringes fitted with needles that retain either large or small amounts of fluid after expulsion. Using previously published viral kinetics data from both naïve subjects infected with HCV and reinfected individuals who had previously cleared an HCV infection, we estimated transmission risk between pairs of serodiscordant injecting drug users, accounting for syringe type, rinsing, and sharing frequency. We calculated that the risk of HCV transmission through syringe sharing increased ~10-fold as viral titers (log IU/ml) increased ~25-fold. Cumulative analyses showed that, assuming sharing episodes every 7 days, the mean transmission risk over the first 6 months was >90% between two people sharing syringes when one had an HCV RNA titer >5 log IU/ml. For those with preexisting immunity that rapidly controlled HCV, the cumulative risk decreased to 1 to 25% depending on HCV titer and syringe type. Our modeling approach demonstrates that, even with transient viral replication after exposure during injection drug use, HCV transmission among people sharing syringes could be reduced through vaccination if an HCV vaccine were available.

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Section: Discussionsupporting

confidence: 89%

“…2 and 3). Our RNA carry-over data were consistent with previous studies on syringe dead space (15,25). The average difference in dead space between low and high dead space syringes has been estimated as 10-fold (26).…”

Section: Parametersupporting

confidence: 90%

Modeling of patient virus titers suggests that availability of a vaccine could reduce hepatitis C virus transmission among injecting drug users

et al. 2018

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“…Pharmacies are the primary source of syringes for most PWID (39, 40), and almost all retail pharmacies sell both low dead space insulin syringes and high dead space syringes (20). The finding that nonmedical prescription opioid injection was independently associated with sharing a high dead space syringe is consistent with findings from a previous study.…”

Section: Discussionmentioning

confidence: 99%

“…The specific reasons for this association are not completely clear. However, several reports have noted that nonmedical prescription opioid users often inject volumes of fluid greater than 1-ml (18, 19), which is the maximum volume of most “low dead space” insulin syringes (20, 21). As a consequence, nonmedical prescription opioid users may be more likely to use standard “high dead space” needles and syringes.…”

Section: Introductionmentioning

confidence: 99%

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

Zule

Oramasionwu

Evon

et al. 2016

The American Journal of Drug and Alcohol Abuse

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Background Nonmedical prescription opioid use has been linked to hepatitis C virus (HCV) infection among people who inject drugs and with using high dead space syringes that retain more blood and transfer more HIV if shared. Little is known regarding its effects on sex risk behaviors. Objectives This paper examines event-level associations between nonmedical prescription opioid use and sharing high dead space syringes (injection risk) and unprotected intercourse (sex risk) behaviors. Methods We recruited 1,985 participants from two overlapping risk groups--drug users and men who have sex with men (MSM)—and their sex partners. Participants completed an interview that included event-level sex questions with recent sex partners and injection questions with recent injection partners. We used multivariable generalized estimating equations (GEE) to assess the associations between nonmedical prescription opioid use and unprotected intercourse during sexual encounters and sharing syringes during injection episodes, while adjusting for within-person correlations. Results When both partners used nonmedical prescription opioids, its use was independently associated with unprotected intercourse in sexual encounters (OR = 2.24; 95% CI = 1.12, 4.49). The use of nonmedical prescription opioids was also associated with sharing high dead space syringes during injection episodes (OR = 6.57; 95% CI = 1.63, 26.51). Conclusion Nonmedical prescription opioid use is associated with an increase in the risk of unprotected sex and sharing high dead space syringes. HIV and HCV prevention interventions for nonmedical prescription opioid users should address sex risk behaviors and encourage the use of acceptable low dead space needles and syringes.

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“…For both HIV and HCV, the transmission risk is related to the volume of blood involved; high dead space syringes, which harbor larger quantities of residual blood, pose the greatest risk among PWID [29,30]. In one study, such syringes comprised nearly half of those available from three major retail pharmacy chains in the US [31].…”

Section: What Are the Current Epidemiological Trends In Hiv And Hcv Amentioning

confidence: 99%

Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C

et al. 2018

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Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.

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Dead space in over-the-counter syringes: The implications for HIV and HCV transmission

Cited by 8 publications

References 13 publications

Modeling of patient virus titers suggests that availability of a vaccine could reduce hepatitis C virus transmission among injecting drug users

Modeling of patient virus titers suggests that availability of a vaccine could reduce hepatitis C virus transmission among injecting drug users

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C

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