High hepatitis C virus prevalence and incidence in a community cohort of young heroin injectors in a context of extensive harm reduction programmes

• Published in: Journal of epidemiology and community health (1979) Vol. 69; no. 6; pp. 599 - 603
• Main Authors: Vallejo, Fernando, Barrio, Gregorio, Brugal, M Teresa, Pulido, Jose, Toro, Carlos, Sordo, Luis, Espelt, Albert, Bravo, María J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2015; BMJ Publishing Group LTD
• Subjects: Adult; Behavior; Bias; Comorbidity; Drug Users - statistics & numerical data; Female; Harm Reduction; Health risk assessment; Hepacivirus - isolation & purification; Hepatitis; Hepatitis C - epidemiology; Hepatitis C - prevention & control; Hepatitis C - transmission; Hepatitis C virus; Heroin Dependence - complications; Heroin Dependence - epidemiology; Heroin Dependence - rehabilitation; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Incidence; Infections; Interviews; Male; Needle-Exchange Programs; Opiate Substitution Treatment; Prevalence; Prevention; Seroconversion; Sexual Behavior; Short reports; Spain - epidemiology; Studies; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - rehabilitation; Young Adult; Spain; Europe; ANE, Spain; HEPATITIS; SUBSTANCE ABUSE; EPIDEMIOLOGY
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech-2014-205070

Background Cohort studies on hepatitis C virus (HCV) among drug injectors are scarcer than studies on HIV. Combined harm reduction interventions (HRIs) can prevent HCV infection. Spain has a medium–high coverage of HRIs. Methods 513 young heroin users who injected drugs in the past 12 months (recent injectors) were street-recruited in 2001–2003 and followed until 2006 in three Spanish cities; 137 were anti-HCV seronegative, 77 of whom had ≥1 follow-up visit. Dried blood spots were tested for anti-HCV. HCV incidence and predictors of infection were estimated using Poisson models. Results At baseline, 73% were anti-HCV positive. Overall incidence (n=77) of HCV seroconversion was 39.8/100 person-years (py) (95% CI 28.7 to 53.8). Excluding non-injectors during follow-up from the analysis (n=57), HCV incidence was 52.9/100 py (95% CI 37.4 to 72.5). Injecting at least weekly (incidence rate ratio (IRR)=5.2 (95% CI 2.5 to 11.1)) and having ≥2 sexual partners (IRR=2.2 (95% CI 1.1 to 4.7)) were independent predictors of HCV seroconversion; drug-injection history <2 years was marginally associated (IRR=2.4 (95% CI 0.9 to 4.7)). HCV incidence may have been underestimated due to differential attrition. Conclusions Despite fairly high HRI coverage among Spanish drug injectors, a distressingly high incidence of HCV in a context of high HCV prevalence was found among young heroin injectors.