Incidence and Risk Factors for Hepatitis C Virus Infection among Illicit Drug Users in Italy |
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| Authors: | Enea Spada Giovanni Rezza Anna Rosa Garbuglia Flavia Lucia Lombardo Ornella Zuccaro Francesca Menniti Ippolito Elisabetta Cupellaro Stefania Capone Maria Rosaria Capobianchi Alfredo Nicosia Riccardo Cortese Antonella Folgori Alfonso Mele The Collaborative Study Group |
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| Affiliation: | 1.Department of Infectious Diseases, Viral Hepatitis Unit,Istituto Superiore di Sanità,Rome,Italy;2.Laboratory of Virology,National Institute for Infectious Diseases “Lazzaro Spallanzani”,Rome,Italy;3.National Centre of Epidemiology, Surveillance and Health Promotion,Istituto Superiore di Sanità,Rome,Italy;4.Medical Affairs Department,MSD Italia,Rome,Italy;5.Local Health Unit of Latina,Latina,Italy;6.ReiThera S.r.l,Rome,Italy;7.Department of Molecular Medicine and Medical Biotechnology,University of Naples Federico II,Naples,Italy;8.Keires AG,Basel,Switzerland;9.Calabria Association of Hepatology,Reggio Calabria,Italy |
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| Abstract: | ![]()
So far, only three small outdated studies have investigated hepatitis C virus (HCV) incidence and risk factors among illicit drug users (DUs) in Italy. Thus, during 2007–2010, we conducted a prospective cohort study among DUs attending 17 Italian rehabilitation centers serving urban areas. Two hundred eighty-four HCV-uninfected DUs were prospectively followed by interview and anti-HCV antibody and RNA testing every 6 months. Incidence was calculated using the person-years method. Infection predictors were assessed by time-dependent Cox analysis. Participants were mostly male (83.4%), under opioid substitution therapy (OST) (78.9%), non-injecting DUs (67.9%), and with a mean age of 30.8. Ninety-one of 224 DUs initially under OST interrupted treatment during the follow-up. Overall HCV incidence was 5.83/100 person-years at risk (PYAR) [95% confidence intervals (CI), 3.63–9.38]. The incidence did not significantly differ according the participants’ sociodemographic characteristics or the degree of urbanization of the towns involved in the study. The incidence was higher for DUs under than for those not under OST (6.23 vs 4.50/100 PYAR; p = 0.681). Incidence was also higher for those with than for those without OST interruption (7.17 vs 5.04/100 PYAR; p = 0.55). However, all these differences were non-significant. At last follow-up visit, a significant decrease in frequency of sharing equipment for preparation/using drugs (by injection or not) was observed by analyzing either the whole cohort or DUs under OST only. Anti-HCV seroconversion resulted independently associated with sharing drug preparation/use equipment, backloading, having a HCV-positive sexual partner, or household and (marginally) intravenous injection. In this study, HCV incidence was non-negligible and OST seemed to lack effectiveness in reducing it. In Italy, implementation of combined harm reduction interventions and antiviral treatment of chronically infected DUs would be needed. |
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