Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users

Abstract

Objectives To investigate the impact of harm-reduction programmes on HIV and hepatitis C virus (HCV) incidence among ever-injecting drug users (DU) from the Amsterdam Cohort Studies (ACS). Methods The association between use of harm reduction and seroconversion for human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) was evaluated using Poisson regression. A total of 714 DU were at risk for HIV and/or HCV during follow-up. Harm reduction was measured by combining its two most important components-methadone dose and needle exchange programme (NEP) use-and looking at five categories of participation, ranging from no participation (no methadone in the past 6 months, injecting drug use in the past 6 months and no use of NEP) to full participation (Ն 60 mg methadone/day and no current injecting or Ն 60 mg methadone/day and current injecting but all needles exchanged). Results Methadone dose or NEP use alone were not associated significantly with HIV or HCV seroconversion. However, with combination of these variables and after correction for possibly confounding variables, we found that full participation in a harm reduction programme (HRP) was associated with a lower risk of HIV and HCV infection in ever-injecting drug users (DU), compared to no participation [incidence rate ratio 0.43 (95% CI 0.21-0.87) and 0.36 (95% CI 0.13-1.03), respectively]. Conclusions In conclusion, we found that full participation in HRP was associated with a lower incidence of HCV and HIV infection in ever-injecting DU, indicating that combined prevention measures-but not the use of NEP or methadone alone-might contribute to the reduction of the spread of these infections.

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

“…3,[12][13][14][15] In 2012 and 2014, two reviews were published that estimated a moderate effect of NSPs on reducing HIV transmission by 48% [95% confidence interval (CI) 3% to 72%] and strong evidence for OST reducing HIV transmission by 54% (95% CI 33% to 68%). 16,17 Similar evidence is lacking for the effect of NSPs or OST on HCV infection.…”

“…16,17 However, evidence of their impact on HCV infection incidence among PWID, in combination or alone, is limited. 3,8,[12][13][14][15]20 …”

“…In total, we included 21 published studies 14,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and seven unpublished studies [33][34][35][36][37]59,60 comprising 1827 HCV incident infections and 8789.7 person-years of follow-up. Overall HCV infection incidence ranged between 0.09 and 42 cases per 100 person-years across the studies.…”

The extent of injection site infection in injecting drug users: findings from a national surveillance study

“…However, this needs to be interpreted with care as those reporting needle exchange use in the last year will include not only those making extensive regular use of needle exchange services but also those making irregular or limited use of these services. Studies suggest the consistent high coverage of interventions like needle exchange is needed for them to be effective against bloodborne viruses [35][36][37], and it is likely that such coverage issues would similarly affect their impact on injection site infections. It should also be noted that not all needle exchanges in the UK provide a full range of injecting equipment, and that some IDUs may also have accessed a needle exchange service either as a route to wound care or as a preventive measure following an injection site infection.…”

Chronic hepatitis C in Swedish subjects receiving opiate substitution therapy—Factors associated with advanced fibrosis

“…Despite enrolment in OST programs, only a minority of patients had previously been assessed for HCV, a phenomenon that has been described from other countries (23,24). Subjects without anti-HCV antibodies were characterized by a shorter duration between their first illicit drug injection and OST initiation, suggesting that early enrolment for OST could contribute to the reduction of HCV infection among injecting heroin users (25).…”