Improvements in data reporting needed to prevent, treat HCV/HBV in IDUs

Issue: August 2011

Researchers from Australia have found that approximately 10 million injection drug users worldwide are infected with hepatitis C virus, and nearly 1.2 million have hepatitis B, according to new findings published in The Lancet.

“More [injection drug users] have anti-HCV than HIV infection, and viral hepatitis poses a key challenge to public health,” Louisa Degenhardt, PhD, of the Center for Population Health at the Burnet Institute in Australia, and colleagues wrote. “Variation in the coverage and quality of existing research creates uncertainty around estimates. Improved and more complete data and reporting are needed to estimate the scale of the issue, which will inform efforts to prevent and treat HCV and HBV in [injection drug users].”

Degenhardt and colleagues set out to assess national, regional and global prevalence and population estimates for HCV and HBV in injection drug users (IDUs).

The researchers pooled data from 1,125 serological reports of HCV antibodies (anti-HCV), HBV core antibodies (anti-HBc), and HBV surface antigens (HBsAg) in studies of IDUs with more than 40 participants (<100% HIV-positive) not excluded on the basis of age or sex.

Of 152 countries or territories with reported IDU, the researchers found anti-HCV prevalence among IDUs in 77 countries, ranging from 60% to 80% across 25 countries; 80% or more across 12 countries; and accounting for 82% of all IDUs.

Nearly 10 million IDUs worldwide may have HCV, the researchers estimated, with the largest populations in China (n=1.6 million), the United States (n=1.5 million) and Russia (n=1.3 million). “This value is about 3.5 times larger than the 2.8 million IDUs who are estimated to be living with HIV,” they wrote.

In addition, the researchers identified anti-HBc prevalence across 43 countries and HBsAg status in 59 countries (65% and 73% of all IDUs, respectively). Prevalence of HBV varied among countries from 4.2% to 85%; HBsAg prevalence ranged from 5% to 10% in 21 countries and more than 10% in 10 countries. Overall, 6.4 million IDUs may have HBV and 1.2 million may be HBsAg-positive, according to the researchers, with the largest populations in east and southeast Asia and eastern Europe.

“Nelson and colleagues conclude that improved recognition of hepatitis in IDUs and development of comprehensive and effective strategies are needed. No doubt this is true, to some extent,” Joseph J. Amon, PhD, MSPH,of the Human Rights Watch, wrote in an accompanying editorial. “However, the history of HIV in IDUs shows that much more than awareness and evidence-based approaches are needed to bring about change. A lesson to recall is the importance of looking to those most affected (ie, people who use drugs) for guidance and leadership in development of effective responses and identification of barriers to their implementation.”

For more information:

Amon JJ. Lancet. 2011;doi:10.1016/S0140-6736(11)61132-X.

Nelson PK. Lancet. 2011;doi:10.1016/S0140-6736(11)61097-0.

Disclosure: This research was funded by WHO and the US National Institutes of Health (NIDA R01 DA018609).

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