Prevalence of, and risk factors for, hepatitis C virus infection among recent initiates to injecting in London and Glasgow: cross sectional analysis

Abstract

Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors.

The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street‐drug users

“…While several studies have reported associations between HCV seroconversion and syringe sharing, many associations were relatively weak after controlling for other factors; other studies failed to find any association (38)(39)(40)(41). Sharing is highly correlated with behaviours driven by specific drug use patterns.…”

Surveillance and epidemiology of hepatitis B and C in Europe – a review

“…As a result of improved blood transfusion safety serotypes associated with blood transfusions are being replaced by other serotypes especially those related to injecting drug use [44]. Prisoners often have prevalence rates of antibodies to HCV comparable to those of IDUs due to a high proportion of IDUs among this group [46][47][48][49][50][51][52][53][54]. In Germany, Spain and in UK the anti-HCV prevalence in sex workers ranged from 0.7 to 9.0 %; with the lowest estimate in Germany [20,23,24].…”

Testing Strategy To Identify Cases of Acute Hepatitis C Virus (HCV) Infection and To Project HCV Incidence Rates

“…However, new infections still occur at high rates in other at-risk populations, especially injection drug users (IDU). Worldwide, the prevalence of HCV infection among IDU ranges from 25% to 80% (14,21,22,27,34,45), and the incidence among younger IDU ranges from 9% to 38% per year (13,16,23,37,49).Monitoring HCV infection has principally been limited to serosurveys detecting HCV-specific antibodies (anti-HCV), using enzyme immunoassays (EIAs) and confirmatory recombinant immunoblot assays (RIBAs). However, these cannot differentiate between acute, recent, chronic, and resolved infections, distinctions which would be very useful for HCV surveillance.…”