Women, younger injection drug users have a higher risk for HIV, HCV
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Key takeaways:
- Young people who inject drugs and women who inject drugs had higher risk for HIV and HCV.
- Limited data on incidence underscore the need to monitor global HIV and HCV epidemics among injection drug users.
Results from a systematic review and meta-analysis demonstrated greater risk for hepatitis C virus and HIV infection among women and younger people who inject drugs, according to data reported in The Lancet Gastroenterology & Hepatology.
“Globally, around 18% of people who inject drugs (PWID) are living with HIV and more than 50% have been infected with HCV,” Adelina Artenie, PhD, of the department of population health sciences at Bristol Medical School in the United Kingdom, and colleagues wrote. “Over the past two decades, the incidence rates of HIV and HCV have declined among PWID in some high-income countries (HICs). ... Meanwhile, persistently high levels or outbreaks of HIV and HCV among PWID have been reported in other HICs and low-income or middle-income countries (LMICs).”
They continued: “A better understanding of these shifting epidemiological patterns and the availability of data globally are needed to orient surveillance and programming efforts. However, no global study has summarized HIV and HCV incidence among PWID.”
In a systematic review and meta-analysis, Artenie and colleagues searched Medline, Embase and PsycInfo databases and identified 125 records with data on HIV and HCV incidence among PWID and associations with age and sex. Of these records, 64 estimated HIV incidence (30 HICs, 34 LMICs) from 1987 to 2021 and 66 estimated HCV incidence (52 HICs, 14 LMICs) from 1992 to 2021.
Pooled incidence was 1.7 per 100 person-years (95% CI, 1.3-2.3) for HIV and 12.1 per 100 person-years (95% CI, 10-14.6) for HCV. Compared with older PWID, young PWID had a higher risk for HIV (RR = 1.5; 95% CI, 1.2-1.8) and HCV (RR = 1.5; 95% CI, 1.3-1.8). Similarly, women were at greater risk for HIV and HCV (RR = 1.4; 95% CI, 1.1-1.6 and RR = 1.2; 95% CI, 1.1-1.3, respectively) compared with men.
“Given the higher risks of HIV and HCV acquisition in young vs. older PWID and in women vs. men who inject drugs, age-appropriate and gender-appropriate prevention and harm reduction measures are also urgently needed to serve these subgroups at high risk,” Artenie and colleagues concluded. “Factors other than age and sex or gender are also likely to be influencing HIV and HCV acquisition risks (eg, types of drugs injected and the context of injection, identifying as men who have sex with men and engaging in sex work) and research is also needed to synthesize the role of these other factors to better strengthen HIV and HCV prevention responses.”
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