Hepatitis C virus infection among drug injectors in St Petersburg, Russia: social and molecular epidemiology of an endemic infection

Abstract

Aims-To understand the epidemiology and transmission patterns of hepatitis C virus (HCV), the predominant blood borne-pathogen infecting drug injectors (IDUs), in a part of the former Soviet Union.Design-Cross-sectional respondent driven sample of IDUs. Measurements-Participants were surveyed to collect demographic, medical, and both general and dyad specific drug injection and sexual behaviors. A blood sample was collected to detect antibodies to hepatitis C and to amplify viral RNA for molecular analysis. The molecular data, including genotypes, were analyzed spatially and linkage patterns were compared to the social linkages obtained by respondent driven sampling (RDS) for chains of respondents and among the injection dyads. Setting-St. Petersburg, RF Participants-387Findings-HCV infection was all but ubiquitous: 94.6% of IDUs were HCV-seropositive. Among the 208 viral sequences amplified, genotype 3a predominated (n=119, 56.9%) followed by 1b (n=61, 29.2%), and 1a (n=25, 11.9%). There was no significant clustering of genotypes spatially. Neither genotypes nor closely related sequences were clustered within RDS chains. Analysis of HCV sequences from dyads failed to find associations of genotype or sequence homology within pairs.Conclusions-Genotyping reveals that there have been at least five unique introductions of HCV genotypes into the IDU community in St. Petersburg. Analysis of prevalent infections does not appear to correlate with the social networks of IDUs, suggesting that simple approaches to link these networks to prevalent infections, rather than incident transmission, will not prove meaningful. On a more positive note, the majority of IDUs are infected with 3a genotype that is associated with sustained virologic response to antiviral therapy.

Attitudes towards Hepatitis C and Treatment Willingness in Injection Drug Users: A Follow-up Interview Study

“…In this study 80% reported positive for HCV at baseline, which is corresponding with previous studies [1][2][3][4][5][6]. The NEP has a great role in diagnosing these as 70% of the HCV positive patients reported that they had been diagnosed at the NEP.…”

“…The prevalence of hepatitis C virus (HCV) among injection drug users (IDUs) varies greatly around the world from 36% to 95% [1][2][3][4][5][6]. At the needle exchange program (NEP) in Malmö, 91% tested positive for HCV [1990][1991][1992][1993], and in the same study HCV infection kept spreading despite free access to clean injection tools.…”

High-risk behaviors after release from incarceration among people who inject drugs in St. Petersburg, Russia

“…With an estimated 83,000 individuals who inject drugs in St. Petersburg (Heimer and White, 2010), or about 1.8% of the population, HIV prevalence exceeds 50% (Eritsyan et al, 2013; Niccolai et al, 2010) and more than 90% are infected with HCV (Heimer et al, 2014; Paintsil et al, 2009). Mandatory HIV testing occurs in Russian prisons and it is where many individuals first learn of their HIV infection (Niccolai et al, 2010).…”

Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities

“…In Russia the prevalence of HCV is estimated to be 80% or higher in some locations (Paintsil et al., 2009; Rhodes et al, 2005, 2006). While chronic HCV infection is an independent risk factor for cirrhosis and hepatocellular carcinoma, the synergistic effect of HCV infection and heavy alcohol consumption can hasten the progression to these disorders (Bellentani et al, 1999; Safdar and Schiff, 2004; Tagger et al, 1999).…”