Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews

Abstract

Background Injecting drug use (IDU) is an important risk for viral hepatitis transmission. Detailed, transparent estimates of the scale of the problem at regional and global levels have never been made. We report national, regional and global prevalence and population size estimates for hepatitis C (HCV) and hepatitis B (HBV) among people who inject drugs. Methods Systematic search of peer-reviewed (Medline/Embase/PsycINFO) and grey literature databases, conference abstracts and online resources, with a widely distributed call for additional data. From 4386 peer-reviewed and 1019 grey literature sources, 1125 were reviewed in full. Studies were extracted to a customised database and graded according their methods. Serological reports of HCV antibodies/anti-HCV, HBV antibodies/anti-HBc, and/or HBV surface antigen/HBsAg among IDUs samples with n>40 participants, <100% HIV-positive, and sampling frames that did not exclude participants on the basis of age or sex were included. Using endorsed decision rules, prevalence estimates were calculated with anti-HCV and anti-HBV as proxies for exposure and HBsAg for current infection. These were combined with IDU population sizes to estimate the number of HBV and HCV positive IDUs. Findings Eligible reports of anti-HCV among IDUs were located for 77 countries. Prevalence was 60–80% in 26 countries and >80% in 12. We estimate worldwide about 10.0 million (range 6.0–15.2M) IDUs might be anti-HCV positive. China, (1.6M), the USA (1.5M) and the Russian Federation (1.3M) had by far the largest such populations. HBsAg reports were found for 59 countries, ranging from 5–10% in 21 countries and over 10% in 10. Worldwide, 6.4 million IDU might be anti-HBc positive (2.3–9.7M), and 1.2 million (0.3–2.7M) HBsAg positive. Interpretation The prevalence of anti-HCV among IDUs is far greater than HIV. Viral hepatitis clearly poses a challenge to public health. Variation in the coverage and quality of existing research creates uncertainty around estimates. Better and more complete data and reporting are required to estimate the scale of the problem, to inform efforts to prevent and treat HCV and HBV among IDUs.

Risk of Echocardiographic Pulmonary Hypertension in Individuals with Human Immunodeficiency Virus–Hepatitis C Virus Coinfection

“…More recently, Spikes and colleagues demonstrated macaques infected with SIV and injected with morphine have markedly increased pulmonary vascular changes, with increased numbers of apoptosisresistant cells and advanced plexiform lesions, when compared with morphinetreated, uninfected animals or SIV-infected animals (14). Although in our study IDU was not associated with PASP or PH, it is unknown whether in humans HCV adds another "hit" to the pulmonary vasculature by acting synergistically with injection drugs and/or HIV infection, especially because HIV-HCV coinfection is frequently transmitted via IDU (15,29).…”

“…Intravenous morphine exposure and simian immunodeficiency virus (SIV) act synergistically to promote pulmonary vasculopathy in macaques (14). Injection drug use (IDU) is the most common mode of HCV transmission in the United States, and HIV-HCV coinfection rates among patients with IDU are greater than 50% (15,16). More recently, it has been suggested that interferon (IFN), historically the mainstay of therapy for chronic HCV infection, may be a unique risk factor for drug-induced pulmonary arterial hypertension (2,(17)(18)(19).…”

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

“…HCV infection is highly prevalent among people who inject drugs (PWID), varying from around 60-80% of PWID infected across national samples in Western Europe, the USA and Canada (Nelson et al, 2011). Early diagnosis of HCV provides the best opportunity for effective medical support and the prevention of further transmission (Corey, MendezNavarro, Gorospe, Zheng, & Chung, 2010).…”

Background paper to the revised recommendation for hepatitis B vaccination of persons at particular risk and for hepatitis B postexposure prophylaxis in Germany

“…F Indication group 2: Persons at increased risk of non-occupational exposure.Examples: Persons living together with HBsAg carriers [11,12,13], persons at high risk of acquiring hepatitis B by sexual contact [11,14,15], people who inject drugs [14,16,17], prison inmates [18,19,20], psychiatric inpatients [21,22]. F Indication group 3: Persons at increased risk of occupational exposure.Examples: Health care personnel (HCP) at risk of exposure (including trainees, laboratory personnel, cleaning personnel) [23,24,25], first aiders [26,27], police officers [29], personnel of facilities where an increased prevalence of HBV-infected persons is likely to be present (e.g., correctional facilities, asylum seeker shelters, homes for the handicapped) [18,19,20,27,28,29].…”