Abstract
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 (beta = 0.39 and R(2) = 0.67) or in proportion to cubed HCV prevalence (beta = 0.40 and R(2) = 0.67)]. In SAm/SSA, limited data suggest that mean HIV prevalence is proportional to HCV prevalence (beta = 0.84, R(2) = 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.
Original language | English |
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Pages (from-to) | 311-318 |
Number of pages | 8 |
Journal | Addiction |
Volume | 105 |
Issue number | 2 |
Early online date | 17 Nov 2009 |
DOIs | |
Publication status | Published - Feb 2010 |
Keywords
- Africa South of the Sahara
- Confidence Intervals
- Disease Outbreaks
- HIV Infections
- HIV-1
- Hepacivirus
- Hepatitis C, Chronic
- Humans
- Prevalence
- Risk Factors
- South America
- Substance Abuse, Intravenous