Options for reducing HIV transmission related to the dead space in needles and syringes

Abstract

BackgroundWhen shared by people who inject drugs, needles and syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently.MethodsWe measured dead space in 56 needle and syringe combinations obtained from needle and syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing.ResultsSyringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space syringes with permanently attached needles, 13 μL in high dead space syringes with low dead space needles, 45 μL in low dead space syringes with high dead space needles, and 99 μL in high dead space syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space syringes with permanently attached needles and highest for low dead space syringes with high dead space needles.ConclusionThe dead space in different low dead space needle and syringe combinations varied substantially. To reduce HIV transmission related to syringe sharing, needle and syringe programs need to combine this knowledge with the needs of their clients.Electronic supplementary materialThe online version of this article (10.1186/s12954-017-0207-5) contains supplementary material, which is available to authorized users.

Hepatitis A virus survival on drug paraphernalia

“…32 Depending on the type of the connection between those two components, the dead volume may be as small as 3 µL (permanent needle attachment with small needle size) or as large as 99 µL (large size of detachable needle hub). 33 Larger dead volume not only allows the potentially contaminated liquid to rest in the syringe until its next use, but also encourages PWIDs to practice 'booting'. In an attempt to obtain the entire dose of the drug, blood is commonly drawn back into the syringe and reinjected into the person who uses the drug, introducing a greater risk of transmission to other people who are sharing a needle, if one of the PWIDs is infected with a blood-borne pathogen.…”

Heroin type, injecting behavior, and HIV transmission. A simulation model of HIV incidence and prevalence

“…Although the initial motivation for our paper was the role of BTH in the early HIV epidemic, our conclusions have a much broader contemporary application internationally, for example in Tajikistan and other countries where PH is used, needle and syringe programs routinely distribute HDS syringes and injecting norms (e.g., heating) are not preventing viral transmission [21, 35].…”

“…The volume of the shared blood and viral load is related to the type of syringe as described in Zule et al [21, 22]. If all shared syringes were rinsed once, the shared volume of blood retained in the dead space would be around 0.0063ml resulting in 63 copies of the virion.…”

HIV, Drug Injection, and Harm Reduction Trends in Eastern Europe and Central Asia: Implications for International and Domestic Policy

“…In these instances, the drug solution was commonly extracted from a shared container with the user's needle/syringe, or with the dealer's needle/syringe, and front-or back-loaded into the user's syringe [48]. The use of high-dead-space syringes, where larger volumes of contaminated blood remain after injection, has also been associated with higher HIV transmission in PWID [49].…”