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

Peter Vickerman, Margaret May, Mirjam Kretzschmar, Lucas Wiessing, Matthew Hickman

Research output: Contribution to journalReview article (Academic Journal)peer-review

63 Citations (Scopus)

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 languageEnglish
Pages (from-to)311-318
Number of pages8
JournalAddiction
Volume105
Issue number2
Early online date17 Nov 2009
DOIs
Publication statusPublished - 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

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