Prevalence and Correlates of Hepatitis C Virus Infection among Street-Recruited Injection Drug Users in San Juan, Puerto Rico

Abstract

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.

Chronic hepatitis C in the Latino population

“…The study documented that HCVseronegative patients who initiated injection drug use had a 57% infection rate within a year. Similar to other studies, predictors for HCV infection were increasing years of injection, injecting in shooting galleries, and self-reported history of STD [ 17 ]. This study also confi rmed reports of higher rates of both HCV and HBV infection, STDs, HIV infection, and AIDS in Latinos who are IDUs [ 17 , 19 ].…”

“…HCV infection is associated with increasing years of injection, injecting in shooting galleries, tattooing while in prison, and selfreported history of sexually transmitted disease (STD) [ 17 ]. In a study assessing the prevalence of viral infections among drug users in Los Angeles County, California, predictors of total number of coinfections were age at fi rst infection, lifetime years in jail, and Latino ethnicity.…”

Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug Users in Tehran, IR Iran

“…Other studies also found HCV infection to be unrelated to sexual practices (26,33,35,40,41), confirming that hepatitis C among IDUs appears to be a consequence of repeated exposure to contaminated injection equipment.…”

“…This finding indicates a more rapid rate of infection and suggests that infection occurs shortly after the initiation of injection practices. Other reports have also reported a rapid increase in HCV infection upon initiation of drug injection (35)(36)(37)(38). The high prevalence of hepatitis C infection among IDUs participating in high-risk behaviors such as needle sharing make unsafe injection the primary cause of hepatitis C transmission in developed countries (5, 34).…”

The Law (and Politics) of Safe Injection Facilities in the United States

“…3 Injection drug users (IDUs) are at high risk of acquiring hepatitis and HIV. [4][5][6][7] Skin abscesses and endocarditis can result from unsterile injection. 8 A recent wave of fentanylrelated overdose deaths has called attention to the high number of fatal overdoses among IDUs.…”