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Women who inject drugs have been shown to have higher incidence of HIV and risk behaviors than men, but there are conflicting reports about hepatitis C virus (HCV) incidence. We systematically reviewed the literature to examine the female to male (F:M) HCV incidence in female and male persons who inject drugs (PWID), and also to explore the heterogeneity (i.e., methodological diversity) in these differences. We searched PubMed and EMBASE for studies published between 1989 to March 2015 for research that reported incidence of HCV infection by sex or HCV incidence F:M rate ratio. A total of 28 studies, which enrolled 9,325 PWID were included. The overall pooled HCV incidence rate (per 100 person-years observation) was 20.36 (95%CI: 13.86, 29.90) and 15.20 (95%CI: 10.52, 21.97) in females and males, respectively. F:M ratio was 1.36:1 (95%CI: 1.13,1.64) with substantial heterogeneity (I-squared = 71.6%). The F:M ratio varied by geographic location: from 4.0 (95%CI: 1.80, 8.89) in China to 1.17 (95%CI: 0.95,1.43) in the U.S. In studies which recruited participants from community settings, the F:M ratio was 1.24 (95%CI: 1.03,1.48), which was lower than that reported in the clinical settings (1.72, 95%CI: 0.86,3.45). The number of studies included provided sufficient statistical power to detect sex differences in this analysis. Our findings raise questions and concerns regarding sex differences with respect to the risk of HCV. Both behavioral and biological studies are needed to investigate causes and potential mechanisms as well as sex-specific prevention approaches to HCV infection.

We examine the ethical, social and regulatory barriers that may hamper research on therapeutic potential of certain controversial controlled substances like marijuana, heroin or ketamine. Hazards for individuals and society, and their potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of certain substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may hinder research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns of undue inducement, informed consent, risk to participants, researchers and institutions, justice and liberty germane to the research with illicit and addictive substances. We debate the disparate research stakeholder perspectives and why they are likely to be infected with bias. We propose an empirical research agenda to provide a more evidentiary basis for ethical reasoning.

The risk of sepsis is low. The best probiotic to optimize outcomes has not yet been identified. Potential benefit for CD4 count, recurrence or management of bacterial vaginosis and diarrhea. Uncertain effect on translocation, BV treatment.