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HIV, HCV infection incidence declined in injection drug users
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The incidence of HIV infection declined to zero cases per 100 person-years in injection drug users, and the incidence of hepatitis C virus infection declined to 7.8 cases per 100 person-years from 1988 to 2008. The hepatitis C virus persisted despite efforts to prevent blood-borne infections in injection drug users, according to researchers from Johns Hopkins University.
“Hepatitis C virus (HCV) is nearly 10 times more transmissible by needlestick than is HIV,” the researchers wrote in The Journal of Infectious Diseases. “Prevalence estimates of HCV infection among injection drug users have been reported to exceed 50% in most injection drug user populations, ranging as high as 95%. Sharing a needle even once is enough to transmit or acquire HCV. Harm-reduction measures that have led to declines in HIV infection incidence have not been as successful for HCV infection.”
The researchers analyzed injection drug users to determine trends in HIV and HCV incidence and HCV infection prevalence. They retrieved data from the AIDS Linked to the IntraVenous Experience (ALIVE) study of community-based injection drug users in Baltimore. Trends were calculated from injection drug users who were recruited during four periods: 1988 to 1989, 1994 to 1995, 1998, and 2005 to 2008. All of the participants had reported injection drug use within the past 11 years.
All participants underwent a blood draw at each study visit. Incidence for HIV and HCV were measured among participants who were negative for both at baseline and who had a follow-up visit within 1 year. They analyzed HCV prevalence in a random sample with demographics and risk behaviors similar to the full population.
In the 1988-1989 group, the incidence of HIV infection was 5.5 cases per 100 person-years. This declined to two cases per 100 person-years in the 1994-1995 group, then to zero cases per 100 person-years in the 1998 group and the 2005-2008 group.
The incidence of HCV infection in the 1988-1989 group was 22 cases per 100 person-years. This declined to 17.2 cases per 100 person-years in the 1994-1995 group, but then increased to 17.8 cases per 100 person-years in the 1998 group. The incidence then declined to 7.8 cases per 100 person-years in the 2005-2008 group.
The HCV infection prevalence declined mainly in injection drug users who were younger than 39 years. In people older than 39 years, only the 2005-2008 group showed declining prevalence when compared with the 1988-1989 group.
In an accompanying editorial, Jason Grebely, PhD, and Gregory J. Dore, MBBS, MPH, PhD, said HCV vaccine strategies would be the most efficient approach to controlling the spread of HCV. This, however, has its challenges.
“While candidates are in development, no highly efficacious HCV vaccine has been discovered, and there are challenges of vaccine trials among injection drug users, including vaccine trial design issues, and ethical issues given the social marginalization and vulnerability of injection drug users,” they wrote. “Efforts to discover an HCV vaccine are crucial.”
For more information:
- Grebely J. J Infect Dis. 2011;203:571-574.
- Mehta SH. J Infect Dis. 2011;203:587-594.
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