Coinfections by HIV, hepatitis B and hepatitis C in imprisoned injecting drug users

In order to know the prevalence and risk factors for coinfections by human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among injecting drug users (IDUs), a cross-sectional study was carried out in two prisons of the province of Cantabria, northern Spain. Three hundred and sixty-two IDU inmates were recruited. All inmates were interviewed and their blood tested for HIV, HBV and HCV. Crude and multiple risk factor adjusted for (by polychotomous logistic regression) odds ratios were calculated. Prevalence of HBV-HCV coinfection (42.5%) was higher than HIV-HBV-HCV coinfection (37.3%), whereas monoinfections were very uncommon (overall: 13%). Long-term injectors and reincarceration were the foremost risk factors for both coinfections, showing a trend between the degree of association and the number of viruses infecting a patient. No significant relationship between coinfection status and sexual practices was observed. The results related to coinfections are consistent with previous studies of prevalence and risk factors for HIV, HBV and HCV, in indicating that the high rates of coinfections among IDU inmates emphasise the need to harm-reduction policy across prisons in Spain.     

佛山市吸毒人群艾滋病、乙型肝炎、丙型肝炎及梅毒感染状况调查

目的 了解佛山市吸毒人群HIV、肝炎和梅毒的感染情况,为预防、控制和治疗提供参考依据。方法 对佛山市2003年部分在押吸毒人员进行HIV、HBV、HCV和梅毒血清学检测。结果 706名吸毒者血液标本中,抗-HIV、HBsAg、抗-HCV及梅毒抗体阳性率分别为3．5％、21．1％、60．1％和5．9％。在检出的25例HIV感染者中,HIV／HBV、HIV／HCV、HIV／TP双重感染率分别为32．0％(8／25)、40．0％(10／25)和4．0％(1／25),HIV／HBV／HCV三重感染率为28．0％(7／25),未发现四重感染的现象。结论 应加大对吸毒人群的监测和防病知识宣传力度,开展干预措施,降低HIV等疾病在高危人群中扩散和传播的危险性。     

Case-reporting of acute hepatitis B and C among injection drug users

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute bepatitis B and C reported to the bealth department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both bad acute bepatitis B. The upper 95% confidence limit for case-reporting of bepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute bepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.     

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey

Background  

Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV.     

Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

Background  

Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada.     

Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users

We sought to examine the relationship between housing status and risk of HIV-infection among injection drug users in Vancouver, Canada. Using Kaplan-Meier survival analysis, we found an elevated HIV incidence rate among those who reported residing in unstable housing (log-rank p=0.006). In Cox's regression survival analysis, unstable housing remained marginally associated with elevated risks of HIV infection (relative hazard=1.40 (95% confidence interval: 0.09-2.00); p=0.084) after adjustment for potential confounders including syringe sharing. Adjusted generalized estimating equations analysis that examined factors associated with unstable housing demonstrated that residing in unstable housing was independently associated with several HIV risk behaviours including borrowing used needles (adjusted odds ratio (OR)=1.14) and sex-trade involvement (adjusted OR=1.19). Our findings suggest that unstable housing environments are associated with elevated risk of HIV- infection due to risk behaviours that take place in these environments. Implications for policy including more comprehensive housing interventions (e.g. 'floating support') are discussed.     

The consistency of self-reported HIV risk behavior among injection drug users.

OBJECTIVES. Most studies of risk factors for human immunodeficiency virus (HIV) rely heavily on retrospective self-reports. The degree to which these reports provide reliable information has received little research attention. The purpose of this study was to assess the extent to which the reliability of retrospective self-report data is affected over time. METHODS. Data were examined from a longitudinal study of risk behaviors among injection drug users. Structured interviews were administered to 366 injection drug users who were asked to recall behaviors that they had reported 6, 12, or 18 months earlier. RESULTS. Kappa coefficients showed moderate initial memory loss for injection and sexual risk behaviors. After 6 months, time had little effect on the ability of injection drug users to recall injection and sexual risk behaviors. For ordinal measures of risk, subjects who gave different reports over time were most likely to disagree by one response category. CONCLUSIONS. These findings support the use of retrospective self-reports in assessing HIV risk behaviors among injection drug users. Retrospective inquiry is likely to remain an important method for collecting data over time.     

Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program.

OBJECTIVES. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users. METHODS. Case patients included 28 injection drug users with acute hepatitis B and 20 with acute hepatitis C reported to the health department in a sentinel hepatitis surveillance county; control subjects were injection drug users with no markers of exposure to hepatitis B or C (n = 38 and 26, respectively) attending health department services during the same period. Data were abstracted from clinic records. RESULTS. Seventy-five percent of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of injecting drugs, nonuse of the exchange was associated with a sixfold greater risk of hepatitis B (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 1.5, 20.4) and a sevenfold greater risk of hepatitis C (OR = 7.3; 95% CI = 1.6, 32.8). CONCLUSIONS. The results suggest that use of the exchange led to a significant reduction in hepatitis B and hepatitis C in the county and may have also prevented a substantial proportion of human immunodeficiency virus infections in injection drug users.     

Age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus infection among injection drug users admitted to drug treatment in 6 US cities

OBJECTIVES: This study measured age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities. METHODS: Remnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc). RESULTS: Prevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West. CONCLUSIONS: The need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs.     

Homelessness and HIV risk behaviors among injection drug users

This article uses data from an 8-year study of injection drug users to examine whether homelessness independently influenced the likelihood of engaging in human immunodeficiency virus (HIV) risk behaviors. Fixed effects regression analyses are used to estimate the associations between four different housing contexts and four different behaviours related to transmitting HIV infections. Results showed that 16% of the study group experienced homelessness at some point during the study, and that homelessness was significantly associated with a higher likelihood of frequenting shooting galleries (odds ratio=2.05), but did not have a significant effect on sharing syringes, sharing other injection drug paraphernalia, or participating in paid sex. These results provide limited support for positing homelessness as independently associated with increased levels of HIV-related risk behavior among injection drug users and highlights the need for more research that examines the housing dynamics among this population.     

Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses.

OBJECTIVES: The purpose of this study was to estimate the prevalence and correlates of four blood-borne viral infections among illicit drug injectors with up to 6 years of injecting experience. METHODS: We analyzed data from 716 volunteers recruited in 1988 and 1989. Test results for hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus, type 1 (HIV), and human T-lymphotropic virus types I and II (HTLV) were examined across six sequential cohorts defined by duration of drug injection. RESULTS: Overall, seroprevalence of HCV, HBV, HIV, and HTLV was 76.9%, 65.7%, 20.5% and 1.8%, respectively, and 64.7%, 49.8%, 13.9%, and 0.5%, respectively, among those who had injected for 1 year or less. Among the newest initiates, HCV and HBV were associated with injecting variables, and HIV was associated with sexual variables. CONCLUSIONS: The high rates of HCV, HBV, and HIV infections among short-term injectors emphasizes the need to target both parenteral and sexual risk reduction interventions early. Renewed efforts at primary prevention of substance abuse are indicated.     

Drug trafficking routes and hepatitis B in injection drug users, Manipur, India

Prevalence of hepatitis B genotype C in injection drug users in the northeastern Indian state of Manipur, neighboring the "Golden Triangle," correlates well with overland drug-trafficking routes, the injection drug use epidemic, and the spread of HIV. Further spread to other regions of India through mobile populations is possible.     

某县注射吸毒人群HIV感染率和危险因素研究

目的 评估某县注射吸毒人群HIV感染率,探讨HIV感染相关的危险因素。方法 在某县戒毒所和社区征集满足条件的吸毒者,由经统一培训的调查员在单独的房间内进行访谈,同时采集血样进行HIV抗体检测。结果 调查注射吸毒人群269人,HIV感染率为26．0％（70／269）。在多因素非条件Logistic回归模型中,注射吸毒人群HIV感染有统计学意义。危险因素包括家庭所在地为县城（相对于其他乡镇）（OR=4．08,95％CI：1．65～10．08）、注射总次数≥1000次组（OR=7．45,95％CI：2．62～21．16）或注射总次数100～999次（OR=3．03,95％CI：1．04～8．86）,在戒毒所内有共用针具行为（OR=8．32,95％CI：2．77～24．98）或仅有戒毒所外共用针具行为（OR=5．54,95％CI：1．97～15．60）。结论 目前该县注射吸毒人群HIV流行处于较高水平,需加强共用针具危险性的宣传教育,加强打击毒品隐蔽进入戒毒所的力度。     

Low perceived benefits and self-efficacy are associated with hepatitis C virus (HCV) infection-related risk among injection drug users

Hepatitis C prevention counselling and education are intended to increase knowledge of disease, clarify perceptions about vulnerability to infection, and increase personal capacity for undertaking safer behaviours. This study examined the association of drug equipment sharing with psychosocial constructs of the AIDS Risk Reduction Model, specifically, knowledge and perceptions related to hepatitis C virus (HCV) among injection drug users (IDUs). Active IDUs were recruited between April 2004 and January 2005 from syringe exchange and methadone maintenance treatment programs in Montreal, Canada. A structured, interviewer-administered questionnaire elicited information on drug preparation and injection practices, self-reported hepatitis C testing and infection status, and AIDS Risk Reduction Model constructs. Separate logistic regression models were developed to examine variables in relation to: (1) the sharing of syringes, and (2) the sharing of drug preparation equipment (drug containers, filters, and water). Among the 321 participants, the mean age was 33 years, 70% were male, 80% were single, and 91% self-identified as Caucasian. In the multivariable analyses, psychosocial factors linked to syringe sharing were lower perceived benefits of safer injecting and greater difficulty to inject safely. As with syringe sharing, the sharing of drug preparation equipment was associated with lower perceived benefits of safer injecting but also with low self-efficacy to convince others to inject more safely. Interventions should aim to heighten awareness of the benefits of risk reduction and provide IDUs with the skills necessary to negotiate safer injecting with their peers.     

Seroprevalence of viral hepatitis A, B and C in intravenous drug users

Markers of viral hepatitis A-C of 99 intravenous drug users predominantly (in 96%) from the Karviná district were examined from March 1998 to February 1999. Pervitin (methamphetamine) was the basic drug in all subjects. Anti-HAV was detected in 6.4% of VHA non-vaccinated individuals, anti-HAV/IgM was not found in any case, HBsAg was detected in 4.0% (acute VHB was diagnosed in all these cases), anti-HBc in 9.2% and anti-HCV in 25.0% of the investigated cases. Our results confirmed the importance of drug use by injection, esp. needle sharing, for the spread VHB and VHC. In case of VHA the fecal-oral route of transmission in this subpopulation is dominant.     

Tattoos, incarceration and hepatitis B and C among street-recruited injection drug users in New Mexico, USA: update

To the Editor:In a previous report [1], we described significant risks for hepatitis B (HBV) and hepatitis C (HCV) positivity associated with receipt of tattoos, particularly while incarcerated, among a street-recruited population of injection drug users (IDUs) in New Mexico, United States from 1995 to 1997. Another recent report in this Journal, based on a study conducted on prisoners in Australia, found tattooing in prison to be an independent risk for HCV [2]. Another report also described a strong association between tattoos and HCV, but found the strongest association to be with commercial tattooing venues [3]. That study found the risk associated with receipt of tattoos in prison elevated, but not statistically significant. That same report reviewed other articles and found a significant risk for HCV infection associated with tattoos in six out of eight studies that had data available. Further, a recent U.S. Centers for Disease Control and Prevention (CDC) document summarized the literature on risks for hepatitis infections in correctional settings and developed extensive control guidelines [4].     

Gender and HIV risk behavior among intravenous drug users in Sichuan Province, China

Using data from a community-based study of injection drug users (IDUs) in Sichuan Province in China, this study compared the level of HIV risk behavior (needle sharing and unsafe sex) amongst female and male IDUs, and examined the risk factors separately for these two groups. Five risk factors were examined in the analysis, including a lack of family support, having an IDU primary sex partner, economic pressure, lack of access to a methadone program, and younger age. Regression results showed that male and female IDUs had different risk factors. For male IDUs, younger age and a lack of family support increased their level of HIV risk behavior. For female IDUs, having an IDU primary sex partner and economic pressure were predictive of their HIV risk behavior. Sex differences in risk factors are explained with respect to gender norms surrounding HIV risk behavior in the context of social relations. Female IDUs who were sex workers suffered additional HIV risk due to their powerlessness in negotiating safe sex with male customers. Practical implications of the findings for HIV/AIDS prevention and intervention work in China are discussed.     

阳江市静脉吸毒人群艾滋病、丙型肝炎感染情况及相关知识、行为调查

目的 了解阳江市静脉吸毒者的艾滋病病毒和丙型肝炎病毒的感染状况及相关知识、高危行为,为制订相应的干预措施提供依据。方法 对阳江市阳东县某戒毒所和某社区的静脉吸毒者进行面对面问卷调查,并采静脉血检测HIV和HCV抗体。结果 235名静脉吸毒者年龄在20～40岁的218人,占总数的92．8％。91．1％静脉吸毒者为小学或初中文化程度;静脉吸毒者HIV和HCV感染率分别为40．4％和98．7％;静脉吸毒者对艾滋病相关知识总知晓率为35．3％;最近一次性生活时安全套使用率为3．6％;77．4％静脉吸毒者有共用针具行为。结论 阳江市静脉吸毒者HIV和HCV感染率较高,对艾滋病相关知识总知晓率低,艾滋病感染危险行为率高,应尽快采取有力的干预措施遏制艾滋病在该类人群中的传播。