Higher incidence of HCV in females compared to males who inject drugs: A systematic review and meta‐analysis

Abstract

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.

Hepatitis C Virus Seroprevalence and Associated Risk Factors Among Male Drug Injectors in Kermanshah, Iran

“…The primary risk factor for HCV infection in PWID is using a needle or syringe, which has been already used by another user (sharing syringes) (13,15,(19)(20)(21)(22)(23). Sharing other injection equipments (eg, cookers, swabs, tourniquets, and mixing water) is also common among PWID (24)(25)(26)(27)(28).…”

Prevalence of HCV among people who inject drugs in Brussels—a respondent-driven sampling survey

“…The female PWID in the current study tested significantly more positive on HCV antibodies than the male respondents. A systematic review and meta-analysis of 28 studies published globally found an overall higher risk of HCV infection of 36% for female PWID compared with male PWID [35]. Since the profile of these women in the current study did not vary significantly from men for other variables, it is necessary to study the behavioral or structural factors contributing to sex-related differences more in detail in future research.…”

Prevalence of HCV among people who inject drugs in Brussels – A Respondent Driven Sampling Survey

“…The female PWID in the current study tested significantly more positive on HCV antibodies than the male respondents. A systematic review and meta-analysis of 28 studies published globally found an overall higher risk of HCV infection of 36% for female PWID compared to male PWID [35]. Since the profile of these women in the current study did not vary significantly from men for other variables, it is necessary to study the behavioral or structural factors contributing to sex related differences more in detail in future research.…”