Hepatitis C virus infection among injecting drug users in Scotland: a review of prevalence and incidence data and the methods used to generate them

Abstract

It is estimated that of 50,000 persons in Scotland (1% of the county's population), infected with the hepatitis C virus (HCV), around 90% injected drugs. This paper reviews data on the prevalence and incidence of HCV, and the methods used to generate such information, among injecting drug users (IDUs), in Scotland. The prevalence estimate for HCV among IDUs in Scotland as a whole (44% in 2000), is comparable with those observed in many European countries. Incidence rates ranged from 11.9 to 28.4/100 person-years. The data have shaped policy to prevent infection among IDUs and have informed predictions of the number of HCV-infected IDUs who will likely progress to, and require treatment and care for, severe HCV-related liver disease. Although harm reduction interventions, in particular needle and syringe exchanges and methadone maintenance therapy, reduced the transmission of HCV among IDUs during the early to mid-1990s, incidence in many parts of the country remains high. The prevention of HCV among IDUs continues to be one of Scotland's major public health challenges.

Testing Strategy To Identify Cases of Acute Hepatitis C Virus (HCV) Infection and To Project HCV Incidence Rates

“…However, new infections still occur at high rates in other at-risk populations, especially injection drug users (IDU). Worldwide, the prevalence of HCV infection among IDU ranges from 25% to 80% (14,21,22,27,34,45), and the incidence among younger IDU ranges from 9% to 38% per year (13,16,23,37,49).Monitoring HCV infection has principally been limited to serosurveys detecting HCV-specific antibodies (anti-HCV), using enzyme immunoassays (EIAs) and confirmatory recombinant immunoblot assays (RIBAs). However, these cannot differentiate between acute, recent, chronic, and resolved infections, distinctions which would be very useful for HCV surveillance.…”

The Role of Community-Mindedness in the Self-Regulation of Drug Cultures

“…Taylor 2005 ;Roy et al 2007 ; as well as users interviewed in the present study express concern regarding the high hepatitis C rates amongst Shetland drug injectors, rates published by CDT and ISD Scotland are with one to two incidents in most years relatively low. Still, poor documentation might come into play here again, otherwise a certain proportion of clients might not have been tested and, moreover, the dark fi gure of injectors not in drug treatment has so far not been estimated.…”

Effects of Comorbid Opiate Dependency on Patients Admitted for Alcohol detoxification: Retrospective Chart Review and 2 Year Outcome

“…Individuals with opiate dependence are at increased risk of developing Hepatitis C infection, the majority of which remain undiagnosed [9] and alcohol abuse further exacerbates disease progression.…”

“…The level of alcohol dependence in the UK population is 4% [2] but levels are much higher in opiate users for example 20-40% of patients undergoing opiate replacement therapy had alcohol dependence [3][4][5][6].There is evidence to suggest that chronic alcohol abuse is an important cause of medical complications during methadone treatment [7], which is frequently linked to premature discharge from treatment [8] and is associated with increased mortality rates [9]. Individuals with opiate dependence are at increased risk of developing Hepatitis C infection, the majority of which remain undiagnosed [9] and alcohol abuse further exacerbates disease progression.…”