Can hepatitis C virus prevalence be used as a measure of injection-related human immunodeficiency virus risk in populations of injecting drug users? An ecological analysis
Article first published online: 17 NOV 2009
© 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction
Volume 105, Issue 2, pages 311–318, February 2010
How to Cite
Vickerman, P., Hickman, M., May, M., Kretzschmar, M. and Wiessing, L. (2010), Can hepatitis C virus prevalence be used as a measure of injection-related human immunodeficiency virus risk in populations of injecting drug users? An ecological analysis. Addiction, 105: 311–318. doi: 10.1111/j.1360-0443.2009.02759.x
- Issue published online: 11 JAN 2010
- Article first published online: 17 NOV 2009
- Submitted 21 April 2009; initial review completed 29 June 2009; final version accepted 27 July 2009
- Ecological analysis;
- hepatitis C;
- injecting drug use;
- systematic review
Background Human immunodeficiency virus (HIV) outbreaks occur among injecting drug users (IDUs), but where HIV is low insight is required into the future risk of increased transmission. The relationship between hepatitis C virus (HCV) and HIV prevalence among IDUs is explored to determine whether HCV prevalence could indicate HIV risk.
Methods Systematic review of IDU HIV/HCV prevalence data and regression analysis using weighted prevalence estimates and time–series data.
Results HIV/HCV prevalence estimates were obtained for 343 regions. In regions other than South America/sub-Saharan Africa (SAm/SSA), mean IDU HIV prevalence is likely to be negligible if HCV prevalence is <30% (95% confidence interval 22–38%) but increases progressively with HCV prevalence thereafter [linearly (β = 0.39 and R2 = 0.67) or in proportion to cubed HCV prevalence (β = 0.40 and R2 = 0.67)]. In SAm/SSA, limited data suggest that mean HIV prevalence is proportional to HCV prevalence (β = 0.84, R2 = 0.99), but will be much greater than in non-SAm/SSA settings with no threshold HCV prevalence that corresponds to low HIV risk. At low HCV prevalences (<50%), time–series data suggest that any change in HIV prevalence over time is likely to be much smaller (<25%) than the change in HCV prevalence over the same time-period, but that this difference diminishes at higher HCV prevalences.
Conclusions HCV prevalence could be an indicator of HIV risk among IDUs. In most settings, reducing HCV prevalence below a threshold (30%) would reduce substantially any HIV risk, and could provide a target for HIV prevention.