Hepatitis C Virus Seroconversion among Young Injection Drug Users: Relationships and Risks

Hahn, Judith A.; Page, Kimberly; Lum, Paula J.; Bourgois, Philippe; Stein, Ellen; Evans, Jennifer L.; Busch, Michael P.; Tobler, Leslie H.; Phelps, Bruce H.; Moss, Andrew R.

doi:10.1086/345554

Cited by 298 publications

(262 citation statements)

References 38 publications

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“…This observation is consistent with studies of HCV incidence among young IDUs over shorter time periods, both locally and internationally. 9,[19][20][21][22] While there was no detectable increase in prevalence among the older cohorts during the decade of study, we observed that successively older cohorts had a successively higher prevalence of HCV. This pattern may represent decreasing incidence rates within cohorts over time, with a progressive increase in HCV prevalence towards a common plateau of approximately 90%.…”

Section: Discussioncontrasting

confidence: 61%

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

2008

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High hepatitis C virus (HCV) prevalence has been documented among many injecting drug user (IDU) populations worldwide; however, there is limited published data on trends in incidence of infection in these epidemics over time. To address this, we used a novel method of analyzing data collected via repeat, cross-sectional sero-surveys by injection initiation cohorts to investigate trends in HCV seropositivity among a population of needle and syringe program (NSP) attendees in Australia between 1995 and 2004, and thereby infer annual incidence trends. Injection initiation cohorts were defined by their time of entry into the IDU population. We also investigated the associations between HCV antibody seroprevalence and risk factor data, and trends in risk factor data over the decade. Approximately 20,000 NSP attendees participated in the study over the 10-year period. Within each injection initiation cohort, we found an increase in HCV prevalence over time, with prevalence appearing to reach saturation around 90%. There was little indication that the slopes of increase had changed with more recent initiation cohorts. While duration of injecting was most strongly associated with HCV seropositivity in this study, we also found that self-reported history of needle and syringe sharing and imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting, with the exception of IDUs who have 15 or more years injecting experience. In this group, recent risk behavior had no relationship to prevalence. In summary, our findings suggest a persistent HCV epidemic despite significant harm reduction efforts in Australia since the mid-1980s, with HIV incidence effectively constant in successive initiation cohorts.

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Section: Discussioncontrasting

confidence: 61%

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

2008

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“…Apart from syringe sharing the practice of frontloading/backloading and the sharing of other injection paraphernalia (e.g. spoons, cookers) have to be considered as risk factors [19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany

et al. 2005

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SUMMARYIn two prisons in Berlin, Germany, provision of sterile injection equipment for injecting drug users (IDUs) started in 1998. To assess the programme's impact, the frequency of injecting drug use and syringe sharing, and the incidence of HIV, HBV, and HCV infection were determined in a follow-up study. Of all IDUs (n=174), 75 % continued to inject. After the project start the level of syringe sharing declined from 71% during a 4-month period of previous imprisonment to 11% during the first 4 months of follow-up, and to virtually zero thereafter. Baseline seroprevalences for HIV, HBV, and HCV were 18, 53, and 82 %. HIV and HCV seroprevalence at baseline was significantly associated with drug injection in prison prior to the project start. No HIV and HBV seroconversions, but four HCV seroconversions occurred. The provision of syringes for IDUs in appropriate prison settings may contribute to a substantial reduction of syringe sharing. However, the prevention of HCV infection requires additional strategies.

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“…13 More recent reports have found HCV prevalence from 27 to 39% among IDUs less than 30 years of age. [14][15][16] Incidence rates remain high, from 9 to 34% per year. 8,[14][15][16][17][18] Human immunodeficiency virus caused about 17,000 deaths in 2005.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16] Incidence rates remain high, from 9 to 34% per year. 8,[14][15][16][17][18] Human immunodeficiency virus caused about 17,000 deaths in 2005. 1 In that year, among persons newly diagnosed with HIV infection or AIDS in the 38 areas with confidential name-based reporting, 13% reported injection drug use, 3% reported both injection drug use and male-to-male sex, and 3% reported heterosexual contact with an IDU, so 19% of HIV/AIDS cases were associated with injection drug use.…”

Section: Introductionmentioning

confidence: 99%

Trends in Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Prevalence, Risk Behaviors, and Preventive Measures among Seattle Injection Drug Users Aged 18–30 Years, 1994–2004

et al. 2007

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Injection drug users (IDUs) are at risk for infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Information on time trends in prevalence of these viruses among IDUs and in behaviors influencing their transmission can help define the status of these epidemics and of public health efforts to control them. We conducted a secondary data analysis combining crosssectional data from IDUs aged 18-30 years enrolled in four Seattle-area studies from 1994 to 2004. Participants in all four studies were tested for antibody to HIV (anti-HIV), hepatitis B core antigen (anti-HBc), and HCV (anti-HCV), and completed behavioral risk assessments. Logistic regression was used to investigate trends in prevalence over time after controlling for sociodemographic, drug use, and sexual behavior variables. Between 1994 and 2004, anti-HBc prevalence declined from 43 to 15% (p G 0.001), anti-HCV prevalence fell from 68 to 32% (p G 0.001) and anti-HIV prevalence remained constant at 2-3%. Declines in anti-HBc and anti-HCV prevalence were observed within the individual studies, although not all these declines were statistically significant. The declines in anti-HBc and anti-HCV prevalence remained significant after control for confounding. Although we did not observe coincident declines in injection equipment sharing practices, there were increases in self-reported needle-exchange use, condom use, and hepatitis B vaccination. We conclude that there has been a substantial and sustained reduction in prevalence rates for HBV and HCV infection among young Seattle IDUs, while HIV rates have remained low and stable.

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Hepatitis C Virus Seroconversion among Young Injection Drug Users: Relationships and Risks

Cited by 298 publications

References 38 publications

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany

Trends in Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Prevalence, Risk Behaviors, and Preventive Measures among Seattle Injection Drug Users Aged 18–30 Years, 1994–2004

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