Prevalence of Hepatitis C, HIV, and Risk Behaviors for Blood-Borne Infections: A Population-Based Survey of the Adult Population of T'bilisi, Republic of Georgia

Abstract

Injection drug use and associated hepatitis C virus (HCV) and HIV infections are on the rise in Russia and the republics of the former Soviet Union. While small targeted studies have found widespread drug use and disease among atrisk populations, there have been few attempts to comprehensively evaluate the extent of these epidemics in general post-Soviet societies. We conducted a two-stage cluster randomized survey of the entire adult population of T'bilisi, Republic of Georgia, and assessed the burden of HCV, HIV, and risk behaviors for blood-borne infections in 2,000 study participants. Of the 2,000 surveyed individuals, 162 (8.1%) had injected illicit drugs during their lifetimes. Of the individuals who had injected illicit drugs, 138 (85.2%) reported sharing needles with injection partners. HCV was found in 134 (6.7%) of the total surveyed population but in 114 (70.4%) of those who had injected illicit drugs. We found HIV in only three (0.2%) individuals, all of whom had injected illicit drugs. Injection drug use and high-risk injection practices are very common in Georgia and may be harbingers of a large burden of HCV-associated liver diseases and a potentially serious HIV epidemic in the years to come.

Not All Injection Drug Users Are Created Equal: Heterogeneity of HIV, Hepatitis C Virus, and Hepatitis B Virus Infection in Georgia

“…The low prevalence of HIV infection among IDUs in Georgia found in this survey is consistent with other studies (Butsashvili et al 2001;Shapatava et al 2006;Stvilia et al 2006;Zaller et al 2004) and suggests that there is a window of opportunity to contain the transmission of HIV among this group. However, significant needle sharing and high prevalence of HCV and HBV suggest that Georgia, like many other former Soviet Republics, may be on the verge of an HIV/ AIDS catastrophe.…”

“…Following the collapse of the Soviet Union and the subsequent dismantling of previously stringent border controls, Georgia became a major transit point for the increasingly large poppy harvests trafficked out of Afghanistan (United Nations Office for Drug Control and Crime Prevention 2002 While Georgia has experienced a dramatic increase in illicit drug use during the past ten years, this rise has been far from homogeneous. Georgia has historically been a country of opium and cannabis users, but beginning in the mid to late 1990s, Afghani drug traffickers developed the capability to synthesize heroin within Afghanistan Georgia is experiencing an emerging HIV/AIDS epidemic (Tkeshelashvilli-Kessler et al 2005;Stvilia et al 2006), but absolute numbers of HIV infected individuals have remained low. In contrast, other blood-borne pathogens such as hepatitis C are very common (Butsashvili et al 2001;Stvilia et al 2006;Zaller et al 2004).…”

“…Georgia has historically been a country of opium and cannabis users, but beginning in the mid to late 1990s, Afghani drug traffickers developed the capability to synthesize heroin within Afghanistan Georgia is experiencing an emerging HIV/AIDS epidemic (Tkeshelashvilli-Kessler et al 2005;Stvilia et al 2006), but absolute numbers of HIV infected individuals have remained low. In contrast, other blood-borne pathogens such as hepatitis C are very common (Butsashvili et al 2001;Stvilia et al 2006;Zaller et al 2004). In order to better characterize the drug-using behaviors associated with HIV, HCV, and HBV we recruited and studied 926 IDUs from three cities in Georgia between 1997 and 1998.…”

Prevention of Mother-to-Child Transmission of HIV: The Georgian Experience

“…In Eastern European countries, with more mature epidemics and high prevalence in injecting drug users, sexual transmission from users to non-injecting sexual partners has long been the dominant mode of heterosexual transmission (14). This interpretation is very important as it confirms that as in early years, Georgia's HIV epidemic was driven by IDU (15,16). At the same time, female sexual partners of IDU may serve as bridging population for expansion of HIV epidemic.…”

Confirmatory testing of hepatitis C virus–positive enzyme immunoassay results in limited‐resource countries: should it be attempted?

“…For example, in the Republic of Georgia, the prevalence of confirmed HCV was nearly 8.0 percent among blood donors 25 . A subsequent cluster‐randomized sample of the adult population of Tbilisi, the capital city, found a similar HCV prevalence among the general population along with a high prevalence of current or past illicit injection drug use 29 . These results from Georgia may not be unusual in other developing countries where the burden of HCV has not been evaluated.…”