Predictors of mortality among injecting and non-injecting HIV-negative drug users in northern Thailand

AIMS: To estimate mortality rates among HIV-negative injecting drug users (IDUs) and non-injecting drug users (non-IDUs), and to assess predictors for mortality among the IDUs. DESIGN: Prospective cohort study in northern Thailand with 2-year follow-up. SETTING: IDUs and non-IDUs who were admitted for detoxification treatment for opiate or amphetamine dependence in a regional drug treatment center were screened. After discharge, HIV-negative individuals were followed-up in the community. PARTICIPANTS: A total of 821 HIV-negative drug users [346 IDUs (42%) and 475 non-IDUs, median age = 32; 51% were ethnic minorities]. MEASUREMENTS: All-cause mortality. FINDINGS: There were 33 deaths over 1360 person-years of follow-up. The all-cause mortality rate was 39 per 1000 person-years among IDUs [standardized mortality ratio (SMR) = 13.9], and was 14 per 1000 person-years among non-IDUs (SMR = 4.4). Among male IDUs, the hazards for all-cause deaths were ethnic minority status [adjusted hazard ratio (HR) = 2.9, 95% CI = 1.2-7.2], incident HIV infection (HR = 2.8, 95% CI = 1.1-7.7) and longer duration of drug injection (HR = 1.07, 95% CI = 1.01-1.14). CONCLUSIONS: The mortality among IDUs is high. Being from an ethnic minority, recent HIV acquisition, and a greater number of years of drug injection are predictors of mortality among the IDUs in this region.     

Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco.

Young injection drug users (IDUs) in San Francisco may be at high risk for hepatitis C virus (HCV) infection despite access to several needle exchange venues. The authors conducted a cross-sectional study from 1997 to 1999 in San Francisco to estimate the prevalence and incidence of antibody to HCV (anti-HCV) among street-recruited IDUs under age 30, and to examine risk behaviors and sources of sterile needles. Among 308 participants, the prevalence of anti-HCV was 45%. Using statistical modeling, incidence of HCV infection was estimated to be 11 per 100 person years. Independent risk factors for anti-HCV included age (odds ratio [OR], 1.17 per year; 95% confidence interval [CI], 1.05-1.30), years injecting (OR, 1.21 per year; 95% CI, 1.10-1.34), years in San Francisco (OR, 1.06 per year; 95% CI, 1.00-1.14), first injected by a sex partner (OR, 4.06; 95% CI, 1.74-9.52), injected daily (OR, 3.85; 95% CI, 2.07-7.17), ever borrowed a needle (OR, 2.56; 95% CI, 1.18-5.53), bleached last time a needle was borrowed (OR, 0.50; 95% CI, 0.24-1.02), snorted or smoked drugs in the prior year (OR, 0.48; 95% CI, 0.26-0.89), and injected by someone else in the prior month (OR, 0.50; 95% CI, 0.25-0.99). In the prior month, 88% used at least 1 of several needle exchange venues, and 32% borrowed a needle. We conclude that anti-HCV prevalence is lower than in previous studies of older IDUs, but 11% incidence implies high risk of HCV infection in a long injecting career. Despite access to sterile needles, borrowing of needles persisted.     

Hepatitis C virus infection among injecting drug users in the Czech Republic -- prevalence and associated factors

AIM: To determine the prevalence of, and factors associated with, hepatitis C virus (HCV) infection in the population of Czech injecting drug users (IDUs). DESIGN: Multicentric cross-sectional study. SETTING: A convenience sample of injecting drug users was recruited using the snowball sampling method. PARTICIPANTS: Sample of 760 IDUs from 9 different Czech regions. MEASUREMENT: We used one-drop instant blood tests to determine the anti-HCV antibodies status; a structured questionnaire was completed during the interview with the researcher. We calculated the ratio of positive findings and performed univariate analyses of correlations between predictors and independent variables. Finally, we created a logistic regression model that controlled for age, region of residence, reported sharing of injection paraphernalia, and length of injection drug use and for the interaction between length of injection use and imprisonment in order to assess the predictive value of imprisonment in an individual's history. FINDINGS: 226 participants (29.74% of the tested sample) were found to be anti-HCV positive. After adjusting for the sensitivity of the test, the 'true proportion' was 34.97% (95% CI: 31.56-38.35). Many correlated independent variables were found in the univariate analyses. In our logistic regression model, we have found that imprisonment increases the odds of being anti-HCV positive by a factor of 4.3. CONCLUSION: Anti-HCV seroprevalence remains relatively low in the Czech IDUs population compared to similar populations in the developed countries. Regional differences exist in anti-HCV prevalence within the Czech Republic. The strong association of anti-HCV prevalence with imprisonment history when controlled for other potentially clinically important factors suggests the need for more effective preventive measures in Czech prisons.     

Hepatitis C virus infection: prevalence,predictor variables and prevention opportunities among drug users in Italy

Summary. The study assessed rates and predictor variables of hepatitis C virus (HCV) infection among drug users receiving pharmacological treatment for opiates addiction.
There was a large cohort study in 16 public centres for drug users in north-eastern Italy, with data collected by standardized face-to-face interviews between February 2001 and August 2001.
Of 1095 participants, 74.2% were HCV seropositive. Anti-HCV status was independently associated with duration of drug use of over 10 years, injecting as a route of drug administration, and hepatitis B virus (HBV) and human immunodeficiency virus (HIV) seropositivity. Further statistical analysis was conducted by dividing the subjects on the basis of the duration of heroin use: more or <10 years. In the multivariate analyses, route of drug administration and HBV status were associated with HCV seropositivity among both groups. Less education was associated with HCV among the shorter term drug users. HIV status and having a sexual partner with a history of drug use were associated with HCV seropositivity among the longer term drug users.
Half of the short-term heroin users were still HCV seronegative when starting treatment, suggesting opportunities for reducing new HCV infections. Remarkable was the relationship between vaccination for hepatitis B and HCV serostatus. Being HBV seropositive was strongly associated with being HCV seropositive. But heroin users who had been vaccinated for HBV were not significantly more likely to be HCV seropositive than heroin users who were HBV seronegative. HBV vaccination does not provide biological protection against HCV; however, vaccinating heroin users against HBV may help to create a stronger pro-health attitude among heroin users, leading to a reduction in HCV risk behaviour.     

郴州地区门诊美沙酮吸毒人群HCV感染状况及基因型分布特征

目的了解郴州地区美沙酮门诊静脉吸毒人群的HCV感染状况。方法采集2014年8-9月在郴州市美沙酮门诊中具有静脉吸毒史的181例患者血清,通过逆转录聚合酶链反应(RT-PCR)以及ELISA法分别检测HCV核酸和抗体,并通过测序确定HCV基因型。组间比较采用Mann-Whitney U检验。结果 181例患者中HCV核酸或抗体阳性患者160例,阳性率为88.4%(160/181),其中抗体和核酸阳性(Ig G+RNA+)134例(74%),抗体阳性核酸阴性(Ig G+RNA-)19例(10.5%),抗体阴性核酸阳性(Ig G-RNA+)7例(3.9%);HCV和HBV共感染19例(10.5%)。HCV感染患者中Ig G+RNA+组的ALT和AST水平明显高于Ig G-RNA+组和Ig G+RNA-组(P值均0.01);HCV、HBV单感染患者ALT和AST水平与HBV和HCV共感染患者比较,差异无统计学意义(P值均0.05)。在133例HCV核酸阳性样本中,6a型81例(60.9%),3型36例(27.1%)。结论静脉吸毒人群具有高HCV感染率,HCV感染以6a型和3型为主,且HCV和HBV共感染并不加重肝损伤。     

Prevalence of hepatitis C infection among intravenous drug users in Shanghai

AIM:To characterize the prevalence of hepatitis C virus(HCV)infection among Chinese intravenous drug users(IDUs).METHODS:A total of 432 adult IDUs(95 women and337 men)in Shanghai were included in the study.The third-generation Elecsys Anti-HCV assay(Roche Diagnostics GmbH,Sandhofer Strasse 116,D-68305,Mannheim,Germany)was used to screen for antibodies against HCV.The RIBA strip,a supplemental antiHCV test with high specificity,was performed on all of the samples that tested positive during the initial screening.All of the anti-HCV positive samples were analyzed with a Cobas TaqMan 48 Analyzer(Roche Diagnostics)for direct detection of HCV RNA.All of the HCV RNA-positive samples were sequenced for genotype determination.RESULTS:The preliminary screening identified 262(60.6%)subjects who were seropositive for HCV.Of the 62 females and 200 males seropositive subjects,16(16.7%)and 65(19.3%),respectively,were confirmed by RIBA,yielding an overall HCV seropositive rate of18.8%.Four female(6.5%)and 14 male(7.0%)subjects tested positive for HCV RNA,indicating an active infection rate of 4.2%for the entire study population.The 18 HCV RNA-positive serum samples were genotyped.Seven individuals were genotype 1b,and four were genotype 1a.One individual each was infected with genotypes 2a,2b and 3a.Four subjects were coinfected with multiple strains:two with genotypes 1a and 2a,and two with genotypes 1b and 2a.The active infection rate among HCV-seropositive individuals was22.2%,which was significantly lower than most estimates.CONCLUSION:The prevalence of HCV is relatively low among IDUs in Shanghai,with a spontaneous recovery rate much higher than previous estimates.     

Hepatitis C is more severe in drug users with human immunodeficiency virus infection

Drug users with chronic hepatitis C virus (HCV) infection are frequently co-infected with human immunodeficiency virus-1 (HIV-1), but it is still not clear whether HIV-1 worsens the natural history of hepatitis C. To investigate this, we conducted a multicentre observational study in 163 drug addicts with histologically documented hepatitis C, 92 of whom were also infected with HIV-1: 25 (27%) were CDC stage II, 53 (58%) were CDC stage III and 14 (15%) were CDC stage IV. Eighty-eight (54%) patients had chronic hepatitis (CH) with minimal activity, 28 (17%) had CH with moderate activity, 40 (25%) had CH with severe activity and seven (4%) had active cirrhosis. Twenty-one HIV-negative patients and 15 HIV-positive patients admitted to alcohol abuse (29% vs 16%, P =0.0665). Liver disease was more severe in HIV-positive patients than in HIV-negative ones ( P =0.0198): 34 HIV-positive patients and 13 HIV negatives had severe CH and cirrhosis. These two severe liver diseases were seen more often in HIV-positive patients with a history of alcohol abuse than in HIV-negative patients (10 out of 16 vs seven out of 21). Age, alcohol abuse and distribution of the histological categories of liver disease were statistically different in HIV-infected and HIV-uninfected patients. Multivariate analysis showed that age, alcohol abuse and serum antibodies to HIV were independently associated with severe CH or cirrhosis. Thus, HIV may enhance the risk of severe liver disease in drug users with hepatitis C, independently of the degree of immune dysfunction. Alcohol abuse may contribute independently, aggravating the cause of HCV-dependent liver disease.     

Hepatitis C virus infection in intravenous drug users: prevalence and risk factors

We investigated the relation of drug use and sexual behaviour to hepatitis C virus (HCV) infection among 80 intravenous drug users (IVDU) attending a methadone treatment program in Rome. Antibodies to HCV (anti-HCV) were found in 54/80 of IVDU (67.5%). Presence of anti-HCV was associated with duration of intravenous drug use and frequency of needle sharing (p less than 0.003 and p = 0.02, respectively, by chi-square for trend). No association was found between sexual behaviour and anti-HCV prevalence.     

Hepatitis C virus reinfection in injection drug users

Spontaneous clearance of hepatitis C (HCV) may provide protection against reinfection. In a large community-based cohort study of 3,553 inner-city residents (mainly injection drug users), we identified HCV-infected individuals in whom virological clearance had occurred and compared the rate of reinfection in this group with that observed in previously uninfected members of the same cohort. We identified 926 HCV-uninfected and 658 HCV-infected viremic subjects at baseline, with 152 of 658 (23.1%) spontaneously clearing viremia over a median follow-up of 5.2 years (IQR, 2.8-7.4). At baseline, individuals with HCV clearance were more likely to be HIV coinfected (P < .001) and to be engaged in frequent illicit drug use (P = .004) and injection drug use (P < .001). The occurrence of HCV infection was lower in individuals with previous infection (14/152, 9.2%) compared with that in those without previous infection (172/926, 18.6%), with incidence rates of 1.8 (95% CI, 0.9-3.0 cases/100 person-years) and 8.1 (95% CI, 6.9-9.4 cases/100 person-years) cases/100 person-years, respectively, after accounting for follow-up. In a logistic regression analysis, with previous HCV infection assessed as a covariate with other potential confounding variables (age, sex, ethnicity, HIV infection, housing status, and illicit and injection drug use), individuals with previous HCV infection and viral clearance were 4 times less likely to develop infection than those infected for the first time (adjusted odds ratio, 0.23; 95% CI, 0.10-0.51, P < .001). In conclusion, individuals with clearance of HCV infection may have a lower risk of acquiring HCV than individuals who have never been infected, despite ongoing exposure to HCV.     

Hepatitis C virus and depression in drug users

Objective: Clinical case studies have implicated depression as a possible side-effect of interferon treatment for the Hepatitis C virus (HCV). However, because these studies generally did not include a pretreatment assessment of depression, it cannot be definitively stated whether depression is a side-effect of interferon treatment, a syndrome coexisting with HCV, or a common characteristic of individuals who are vulnerable to HCV infection. To gather more information about this issue, self-reported depressive symptomatology of drug users with HCV who have not received interferon treatment was compared to that of uninfected drug users.
Methods: Subjects were 309 drug users not currently in substance abuse treatment who were participating in a National Institute on Drug Abuse project. Subjects completed the Center for Epidemiological Studies-Depression (CES-D) instrument and provided a blood sample for HCV testing.
Results: Serological findings revealed that 52.4% of the subjects tested positive for HCV antibodies. Of the HCV-positive subjects, 57.2% had significant depressive symptomatology, whereas only 48.2% of the HCV-negative subjects did, for an overall rate of 52.6%. The two groups also differed on two specific dimensions of depression, with the HCV-positive group scoring lower on the Positive Affect scale and higher on the Somatic/Retarded Activity scale.
Conclusions: These findings reveal high levels of depressive symptomatology among drug users, as well as the possibility of a coexisting depressive syndrome with HCV infection. These findings raise the possibility that depression associated with interferon treatment may, at least partially, be accounted for by preexisting depression. Further research is needed to determine the nature and origins of depression in individuals in treatment with interferon for HCV with specific focus placed on determining the dimensions of depression associated with HCV infection and interferon treatment.     

Hepatitis B carrier among married hilltribe women in northern Thailand

A cross-sectional study of 540 married Akha and Lisaw women of reproductive age was conducted in Chiang Rai Province, Thailand, between June 1st and August 31st, 1999, in order to determine the seroprevalence of HBsAg and identify the risk factors for chronic HBsAg carriage. HBsAg was detected by the reverse passive hemagglutination technique (RPHA). Data were obtained by questionnaires and serological testing. There were 164 Lisaws and 376 Akhas: most were illiterate (88.71%) and the annual family income was < or = 9,999 baht (50.93%). The seroprevalence of HBsAg was 8.15%. Logistic regression analysis, controlling for possible confounding factors, revealed that one to five injections in the year prior to the study increased the risk of HBsAg carriage by a factor of 4.84 (95% CI = 1.42-16.49); more than six injections increased the risk by a factor of 5.84 (95% CI = 1.47-23.18).     

Hepatitis C virus infection in Italian intravenous drug users: epidemiological and clinical aspects

Abstract: The epidemological and clinical features of hepatitis C virus infection have been evaluated in a cohort of 227 intravenous drug users enrolled at a drug dependence treatment center in the Veneto area in 1992–1993 and followed periodically. Hepatitis C virus infection was detected using second-generation anti-HCV ELISA in 171 (75%) subjects at enrollment. Anti-HCV seropositivity correlated with: a) the duration of drug abuse: 91% of intravenous drug users injecting for more than 8 years were seropositive as compared to 40% of those with a history of abuse lasting 4 years or less, p<0.001; b) sharing of injection equipment: 85% anti-HCV positive intravenous drug users had shared at some time as compared to 64% seronegative subjects, p<0.001; c) seropositivity for immunodeficiency virus infection: 25% anti-HCV positive intravenous drug users were coinfected as compared to 3.5% anti-HCV negative, p<0.001; d) markers of ongoing (two cases) or previous hepatitis B virus infection were detected in 62% of anti-HCV positive but in 21% of anti-HCV negative cases, p<0.01. Two initially anti-HCV negative intravenous drug users seroconverted during follow up giving an incidence rate of hepatitis C virus infection of 6.2 per 100 person-years. During the survey abnormal alanine aminotransferase levels were detected in 75% anti-HCV positive but in 24% anti-HCV negative cases (p<0.001), with significantly higher levels in the former. These findings suggest that the circulation of hepatitis C virus among intravenous drug users has been decreasing in recent years, although new infections still occur. In agreement with the high rate of chronicization of parenterally transmitted hepatitis C, the majority of anti-HCV positive subjects had biochemical features of associated liver disease.     

Hepatitis C virus infection, HIV co-infection, and associated risk among injecting drug users in Togliatti, Russia

The objective of this study was to estimate the prevalence of hepatitis C virus (HCV) infection and co-infection with HIV among injecting drug users (IDUs) in Togliatti City, Russia. Unlinked anonymous cross-sectional survey of IDUs recruited from community settings, with oral fluid sample collection for HCV and HIV antibody (anti-HCV, anti-HIV) testing, was carried out. The anti-HCV prevalence was 87% (357/411), anti-HIV prevalence 56% (234/418), and 93% (214/230) of HIV-positive IDUs were co-infected with HCV. Only 23% (94/411) of those HCV positive self-reported as such. In an adjusted model, increased odds of HCV positivity were associated with needle and syringe, as well as injecting paraphernalia sharing in the last four weeks. IDUs injecting more than once with the same needle also had raised odds. There were no marked associations between HCV positivity and the duration of injecting or age group. Almost all IDUs were HCV positive, and almost all HIV-positive IDUs were HCV co-infected. There is an urgent need to maximize syringe distribution coverage, develop health promotion targeting HCV prevention for IDUs, and improve access among IDUs to treatments for HIV and HCV infection.     

静脉注射吸毒人群丙型肝炎病毒感染研究进展

吸毒是世界性难题,其导致的公共卫生问题直接影响一般人群的健康.静脉注射吸毒者(IVDUs)人群丙型肝炎病毒(HCV)感染率远远高于一般人群,是重要的传染源.本文概述近年来国内外学者在IVDUs人群HCV感染方面的主要研究成果和观点,探讨IVDUs人群感染HCV的病毒学特点,重点介绍IVDUs人群吸毒方式,吸毒年限,器具共用,性行为特征以及民族差异等因素对该人群感染HCV的影响作用.     

Methadone maintenance and hepatitis C virus infection among injecting drug users

Abstract Harm reduction strategies for the prevention of transmission of human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs) have been widely implemented in Australia and are seen to have been effective in preventing the spread of HIV. A major strategy has been increasing the availability of and accessibility to methadone maintenance therapy (MMT) programmes. We have reviewed the experience of a major MMT general practice with hepatitis C virus (HCV) infection from 1991 to 1995. Of 1741 individuals tested for HCV antibodies at least once 66.7% were positive. Of 73 IDUs who were initially seronegative and were retested at least once, 19 were subsequently seropositive. Seroconverters to HCV were younger than non-seroconverters, and were more likely to have evidence of previous hepatitis B infection. The overall HCV incidence rate was 22 cases per 100 person-years, and this did not differ between those on MMT programs (continuous or interrupted) between HCV tests and those not on MMT. These findings suggest that the role of MMT in the control of the spread of HCV infection among IDUs needs further assessment, and that control of the current epidemic of HCV infection among IDUs in Australia will be very difficult.     

Molecular epidemiology of hepatitis C virus infection among intravenous drug users

Background/Aims: The clinico-pathologic features of hepatitis C virus infection intravenous drug users are different from those found in other hepatitis C virus-infected patients. Our airm was to test whether specific viral variants circulate within this particular patient population.Methods: We studied the distribution of hepatitis C virus genotypes in 90 drug addicts and 484 controls, according to the method described by Okamoto.Results: Hepatitis C virus type 1a and 3a infections were more frequent among intravenous drug users than in 125 age-matched controls (48.8% and 21.1% vs 17.6% and 11.2%), accounting for the majority of infections in intravenous drug users. Analysis of hepatitis C virus genotypes according to age showed that, in the general population, hepatitis C virus types 1a and 3a were more prevalent among patients younger than 40 years of age than in older individual (17.6% and 11.2% vs. 1.4% and 0.6%).Conclusions: These findings suggest that hepatitis C virus types 1a and 3a were recently introduced in Italy, presumably via needle-sharing among intravenous drug users, and from this reservoir they are extending to the general population, particularly among younger subjects.