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Zhao J, Green C, Markham C, Fujimoto K, Nyitray AG, Hwang LY. Association between non-injection drug use and hepatitis C infection among HIV-negative men who have sex with men. BMC Infect Dis 2024; 24:985. [PMID: 39285350 PMCID: PMC11406739 DOI: 10.1186/s12879-024-09685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/29/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Prior research predominantly examined the association between HIV-positive men who have sex with men (MSM) or those using injection drugs and hepatitis C virus (HCV) infection. However, limited attention has been given to understanding the association among HIV-negative MSM who do not inject drugs. This gap leaves apportion of the population unexamined, potentially overlooking important factor that may contribute to the transmission and prevalence of HCV. This study aims to investigate the relationship between non-injection drug use and HCV infection in this population. METHODS In this cross-sectional study, we analyzed data on 118 MSM who reported use of non-injection drugs. The participants were recruited from two inner-city communities in Houston, TX, between 2004 and 2007 and were negative for both HIV and hepatitis B virus infection. Latent class analysis (LCA) was used to identify drug use latent classes. Multinomial logistic regression analysis was used to evaluate the association between drug use latent class and HCV infection. RESULTS Four distinct latent classes of drug use were identified: class 1, persons ≥ 42 years of age who used only crack cocaine; class 2, persons approximately 42 years of age who used > 2 drugs; class 3, persons < 42 years of age who used > 5 drugs; and class 4, persons ≥ 42 years of age who used > 6 drugs. Class 4 was significantly associated with HCV infection. The odds of HCV infection in members of class 4 was 17 times higher than in class 2 members (adjusted odds ratio [aOR] = 16.9, 95% confidence interval [CI]: 1.4-205.4) and almost 22 times higher than in class 3 members (aOR = 21.8, 95% CI: 1.5-322.8). CONCLUSIONS Among MSM with non-injection drug use, the subgroup of individuals who were ≥ 42 years of age and used multiple drugs (including heroin, speedball, methamphetamine, crack cocaine, and marijuana) had a high probability of HCV infection. Public health and education programs, as well as drug treatment and rehabilitation programs, should be developed for this high-risk subgroup of individuals to prevent HCV acquisition and transmission.
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Affiliation(s)
- Jing Zhao
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Charles Green
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Khan MU, Sadia H, Irshad A, Baig AA, Ashiq S, Zahid B, Sheikh R, Roshan S, Ali A, Shamas S, Bhinder MA, Ahmad R. Detection, quantification and genotype distribution of HCV patients in Lahore, Pakistan by real-time PCR. Afr Health Sci 2020; 20:1143-1152. [PMID: 33402959 PMCID: PMC7751519 DOI: 10.4314/ahs.v20i3.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is considered as "Viral Time Bomb" suggested by the World Health Organization and if it is not treated timely, it will lead towards cirrhosis and hepatocellular carcinoma (HCC). OBJECTIVE The purpose of the present research is to study possible risk factors, frequent genotypes of HCV and its association with different age groups. METHODS Suspected blood samples from HCV patients were collected from different hospitals of Lahore, Pakistan. Out of 1000 HCV suspected samples, 920 samples were found HCV positive detected by Anti-HCV ELISA, CobasR. kit. The quantification of HCV load was determined by HCV quantification kit and LINEAR ARRAY KIT (Roche) was used for genotype determination by Real-Time PCR (ABI). Statistical analysis was done by using Microsoft Excel. RESULTS Out of 920 subjects, 77 subjects (8.4%) were false positive and they were not detected by nested PCR. Three PCR positive samples were untypeable. Genotype 3 was predominant in Lahore which was 83.5%, whereas type 1 and 2 were 5.1% and 0.7% respectively. There were also mixed genotypes detected, 1 and 3 were 0.4%, 2 and 3 were 1.41% and 3 and 4 were 0.2% only. Male were more infected of HCV in the age <40 years and females >40years. CONCLUSION The major risk factor for HCV transmission is by use of unsterilized razors/blades. It is necessary to spread awareness among the general population of Pakistan about HCV transmission risk factors. Regular physical examination at least once a year is recommended, so that early detection of HCV could be done.
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Affiliation(s)
- Muhammad Umer Khan
- Faculty of Allied Health Sciences, The University of
Lahore, Lahore, Pakistan
| | - Haleema Sadia
- Department of Biotechnology, Balochistan University of
Information Technology, Engineering and Management Sciences, Quetta, Pakistan
- Center for Applied Molecular Biology, University of the
Punjab, Lahore, Pakistan
| | - Asma Irshad
- Department of Life Sciences, University of Management and
Technology (UMT) Lahore, Pakistan
| | - Atif Amin Baig
- Unit of Biochemistry, Faculty of Medicine, University,
Zainal Abidin
| | - Sana Ashiq
- Center for Applied Molecular Biology, University of the
Punjab, Lahore, Pakistan
| | - Beenish Zahid
- Department of Pathobiology, KBCMA, CVAS, Narowal
sub-campus of University of Veterinary and Animal Sciences, Pakistan
| | - Rozeena Sheikh
- Department of Biotechnology, Balochistan University of
Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Sadia Roshan
- Department of Zoology, University of Gujrat,
Pakistan
| | - Azam Ali
- Molecular Biology and Biotechnology, University of Lahore,
Lahore, Pakistan
| | - Shazia Shamas
- Department of Zoology, University of Gujrat,
Pakistan
| | - Munir Ahmed Bhinder
- Department of Human Genetics and Molecular Biology,
University of Health Sciences, Lahore, Pakistan
| | - Rais Ahmad
- Department of Microbiology, CUVAS, Cholistan,
Pakistan
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Del-Rios NHA, de Araujo LA, Martins RMB, Guimarães RA, de Matos MAD, Caetano KAA, Pinheiro RS, da Silva França DD, da Silva LN, Teles SA, Dos Santos Carneiro MA. Molecular and epidemiological aspects of hepatitis C virus infection among crack cocaine users. J Med Virol 2019; 92:1239-1245. [PMID: 31746475 DOI: 10.1002/jmv.25632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022]
Abstract
The aim is to investigate the prevalence, risk factors, and hepatitis C virus (HCV) genotypes/subtypes among crack users in-treatment in Central Brazil. A cross-sectional survey in which 600 in-treatment crack users were interviewed and tested for anti-HCV Ab by enzyme-linked immunosorbent assay was conducted between August 2012 and April 2013. Anti-HCV-positive samples were also submitted for HCV RNA detection by polymerase chain reaction. Positive HCV RNA samples were genotyped by direct sequencing analysis of the NS5B region of the viral genome, followed by phylogenetic analysis. Of the total, 3.7% (95.0% CI, 2.4%-5.6%) were anti-HCV positive. Age over 40 years and history of injecting drugs were risk factors for HCV, while snorting cocaine was a protector variable. HCV RNA was detected in 14 of 22 anti-HCV-positive samples, and the genotypes 1 (n = 10) and 3 (n = 2), subtypes 1a (n = 7), 1b (n = 3), and 3a (n = 2) were identified. The HCV prevalence found among crack users is almost threefold that observed in the general population in Brazil supporting that this population is at higher risk for HCV. The findings of cocaine insufflation as a protective behavior for HCV infection in this population should be explored.
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Affiliation(s)
| | | | | | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás (UFG), Goiás, Brazil
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Granados-García V, Flores YN, Díaz-Trejo LI, Méndez-Sánchez L, Liu S, Salinas-Escudero G, Toledano-Toledano F, Salmerón J. Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis. PLoS One 2019; 14:e0212558. [PMID: 30807590 PMCID: PMC6391024 DOI: 10.1371/journal.pone.0212558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/05/2019] [Indexed: 02/06/2023] Open
Abstract
Aim This systematic review and meta-analysis characterizes the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDUs) in upper middle-income countries. Methods Five databases were searched from 1990–2016 for studies that took place in countries with a GDP per capita of $7,000 to $13,000 USD. The data extraction was performed based on information regarding prevalence, sample size, age of participants, duration of intravenous drug use (IDU), recruitment location, dates of data collection, study design, sampling scheme, type of tests used in identifying antibody reactivity to HCV, and the use of confirmatory tests. The synthesis was performed with a random effects model. The Cochrane statistical Q-test was used to evaluate the statistical heterogeneity of the results. Results The 33 studies included in the analysis correspond to a sample of seven countries and 23,342 observations. The point prevalence value estimates and confidence intervals of the random effects model were 0.729 and 0.644–0.800, respectively for all seven countries, and were greatest for China (0.633; 0.522–0.732) as compared to Brazil (0.396; 0.249–0.564). Prevalence for Montenegro (0.416; 0.237–0.621) and Malaysia (0.475; 0.177–0.792) appear to be intermediate. Mexico (0.960) and Mauritania (0.973) had only one study with the largest prevalence. A clear association was not observed between age or duration of IDU and prevalence of HCV, but the data from some groups may indicate a possible relationship. The measures of heterogeneity (Q and I2) suggest a high level of heterogeneity in studies conducted at the country level and by groups of countries. Conclusions In this systematic review and meta-analysis, we found that the pooled prevalence of HCV was high (0.729) among a group of seven upper middle income countries. However, there was significant variation in the prevalence of HCV observed in China (0.633) and Brazil (0.396).
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Affiliation(s)
- Víctor Granados-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
- * E-mail:
| | - Yvonne N. Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
- UCLA Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Ángeles, CA, United States of America
| | - Lizbeth I. Díaz-Trejo
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaría de Salud, Ciudad de México, México
| | - Lucia Méndez-Sánchez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Ciudad de México, México
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Stephanie Liu
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
- University of Washington, Department of Epidemiology, School of Public Health, Seattle, WA, United States of America
| | - Guillermo Salinas-Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Ciudad de México, México
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
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Coutinho C, Bastos LS, da Mota JC, Toledo L, Costa K, Bertoni N, Bastos FI. The risks of HCV infection among Brazilian crack cocaine users: incorporating diagnostic test uncertainty. Sci Rep 2019; 9:443. [PMID: 30679480 PMCID: PMC6346030 DOI: 10.1038/s41598-018-35657-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/31/2018] [Indexed: 01/28/2023] Open
Abstract
Despite the initiative by WHO and other international organizations to eliminate HCV in the medium term, hepatitis C infection is still a major public health problem. Even non-injecting drugs users who engage in harmful or addictive drug use are at greater risk of acquiring the infection, when compared to the general population. This study evaluate risk factors for HCV infection in users of crack/cocaine in Brazil, using multilevel models that incorporate variations in the sensitivity and specificity of the respective diagnostic tests. The sample included all the participants of a national survey on street crack cocaine users with serologically reactive result in the rapid test for the HCV as well as 4 non-reactive controls, matched by sex, age category, and major geographic region of residence. Multilevel logistic regression models were used, with and without incorporation of the diagnostic test’s sensitivity and specificity values. The odds of HCV infection were 85% higher among polydrug users, 7.81 times higher among injecting drug users, and 3.69 times higher in those reporting to have genital ulcers. Statistical modeling strategies that incorporate the sensitivity and specificity of diagnostic tests in challenging settings are useful for studying the association between risk factors and infection status.
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Affiliation(s)
- Carolina Coutinho
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil. .,Program of Epidemiology in Public Health, Sergio Arouca National School of Public Health (ENSP), FIOCRUZ, Rio de Janeiro, Brazil.
| | | | - Jurema Corrêa da Mota
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
| | - Lidiane Toledo
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
| | - Katia Costa
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
| | - Neilane Bertoni
- Division of Epidemiology, National Cancer Institute (INCa), Rio de Janeiro, Brazil
| | - Francisco I Bastos
- Institute of Scientific and Technological Communication and Information in Health (ICICT), FIOCRUZ, Rio de Janeiro, Brazil
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Schuch-Goi SB, Scherer JN, Kessler FHP, Sordi AO, Pechansky F, von Diemen L. Hepatitis C: clinical and biological features related to different forms of cocaine use. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 39:285-292. [PMID: 29267513 DOI: 10.1590/2237-6089-2016-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is related with several liver diseases such as cirrhosis and hepatocellular carcinomas, leading to more than 0.5 million deaths every year and to a great global burden. It is known that injection drug users show a high prevalence of HCV infection, being considered a risk group for this disease. Cocaine users seem to be in greater risk than other drug users, and several hypotheses for this association are being studied. AIM To review data on HCV infection in cocaine users, taking into consideration the relevance of the different routes of drug administration and other risk behaviors. METHODS This was a narrative review performed in the main scientific databases. RESULTS AND CONCLUSION Data suggest that cocaine use could be associated with HCV infection due to the specificities of cocaine consumption pattern, even in those subjects who do not inject drugs, in addition to other risky behaviors, such as tattooing and unprotected sex. Injectable cocaine users seem to be more susceptible to contamination than users who do not inject drugs. However, evidence is pointing to the possibility of infection by sharing drug paraphernalia other than syringes. Moreover, specific immune system impairments caused by cocaine use are also being linked with HCV infection susceptibility, persistence and increased pathological effects.
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Affiliation(s)
- Silvia Bassani Schuch-Goi
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliana Nichterwitz Scherer
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Anne Orgler Sordi
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Angulo-Arreola IA, Bastos FI, Strathdee SA. Substance Abuse and HIV/AIDS in the Caribbean. J Int Assoc Provid AIDS Care 2017; 16:56-74. [PMID: 21852689 DOI: 10.1177/1545109711417408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Caribbean and Central America represent a formidable challenge for researchers and policy makers in the HIV field, due to their pronounced heterogeneity in terms of social, economic, and cultural contexts and the different courses the HIV epidemic has followed in the region. Such contrasting contexts and epidemics can be exemplified by 2 countries that share the island of Hispaniola, the French Creole-speaking Haiti, and the Spanish-speaking Dominican Republic. Haiti has experienced the worst epidemics outside of sub-Saharan Africa. Following a protracted economic and social crisis, recently aggravated by a devastating earthquake, the local HIV epidemic could experience resurgence. The region, strategically located on the way between coca-producing countries and the profitable North American markets, has been a transshipment area for years. Notwithstanding, the impact of such routes on local drug scenes has been very heterogeneous and dynamic, depending on a combination of local mores, drug enforcement activities, and the broad social and political context. Injecting drug use remains rare in the region, but local drug scenes are dynamic under the influence of increasing mobility of people and goods to and from North and South America, growing tourism and commerce, and prostitution. The multiple impacts of the recent economic and social crisis, as well as the influence of drug-trafficking routes across the Caribbean and other Latin American countries require a sustained effort to track changes in the HIV risk environment to inform sound drug policies and initiatives to minimize drug-related harms in the region.
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Understanding experiences of and rationales for sharing crack-smoking equipment: A qualitative study with persons who smoke crack in Montréal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:18-26. [DOI: 10.1016/j.drugpo.2017.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 03/20/2017] [Accepted: 05/30/2017] [Indexed: 11/22/2022]
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Waruingi W, Mhanna MJ, Kumar D, Abughali N. Hepatitis C Virus universal screening versus risk based selective screening during pregnancy. J Neonatal Perinatal Med 2016; 8:371-8. [PMID: 26836823 DOI: 10.3233/npm-15915024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We sought to compare the value of HCV universal screening versus risk-based selective screening in pregnant women. STUDY DESIGN In a prospective observational study (Jan 2012 - March 2012), pregnant women, in a high risk inner city clinic, who were at "low risk" for HCV infection were tested for HCV antibodies (universal screening) and their medical records were compared to the medical records of pregnant women who were at "high risk" (risk based selective screening as assessed by their obstetricians' screening questionnaire). RESULTS During the study period, 419 women delivered at our institution with 8.8% (37/419) at high risk for HCV. In 95% (183/193) of available and consenting low risk women, HCV antibody testing was done. The prevalence of HCV was 3.18% (7/220; 95% CI: 1.36-6.50) in all tested women versus 0.95% (4/419; 95% CI: 0.31-2.59) in risk-based selectively tested women. Overall the screening questionnaire had a sensitivity of 0.85 (0.42-0.99) and a specificity of 0.52 (0.45-0.58) in all women who had HCV antibody testing and questionnaire screening. CONCLUSIONS Using a screening questionnaire to identify women at risk for HCV infection during pregnancy under-estimates the real prevalence of HCV. A universal screening should be considered in high risk cities.
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Merabi Z, Naja WJ, Soufia M, Yazbek JC, Rabeh W, Salem BA, Haddad R. Intranasal heroin use – an emerging trend in Lebanon: A single institution study presenting sociodemographic profiles of intranasal versus intravenous users. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1227383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Zeina Merabi
- Department of Cognitive and Behavioral Neurosciences, Lebanese University, Beirut, Lebanon
| | - Wadih J. Naja
- Department of Psychiatry, Lebanese University, Beirut, Lebanon
| | - Michel Soufia
- Department of Psychiatry, Université Saint-Esprit de Kaslik, Beirut, Lebanon
| | | | - Wissam Rabeh
- Department of Clinical Psychology, Lebanese University, Beirut, Lebanon
| | - Bilal A. Salem
- Department of Psychiatry, UCLA Life Sciences, Los Angeles, CA, USA
| | - Ramzi Haddad
- Department of Psychiatry, Lebanese University, Beirut, Lebanon
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Risk for hepatitis B and C virus transmission in nail salons and barbershops and state regulatory requirements to prevent such transmission in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 20:E20-30. [PMID: 25250760 DOI: 10.1097/phh.0000000000000042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT The potential for hepatitis B and C virus (HBV/HCV) transmission in nail salons and barbershops has been reported, but a systematic review has not been conducted. These businesses are regulated by state cosmetology or barbering boards, but adequacy of sanitary requirements has not been evaluated. OBJECTIVES To conduct literature review to assess risk for HBV/HCV transmission in nail salons and barbershops and to evaluate sanitary requirements in HBV/HCV prevention in these businesses in 50 states and District of Columbia. DESIGN Several search engines were used for literature search. Studies that quantified risks associated with manicuring, pedicuring, or barbering were included. State requirements for disinfection and sterilization were reviewed and evaluated. MAIN OUTCOME MEASURE For literature review, odds ratios, 95% confidence intervals, and confounding adjustment were extracted and evaluated. For regulation review, requirements for disinfection or sterilization for multiuse items in nail salons and barbershops were assessed according to the US federal guidelines. RESULTS Forty-six studies were identified and 36 were included in this study. Overall, the results were not consistent on risk for HBV/HCV transmission in nail salons and barbershops. For sanitary requirements, disinfection with an Environmental Protection Agency-registered disinfectant is required in 39 states for nail salons and in 26 states for barbershops. Sterilization was described in 15 states for nail salons and in 11 states for barbershops, but the majority of these states listed it as an optional approach. Sanitary requirements are consistent in states where 1 board regulates both businesses but are substantially discrepant in states with separate boards. CONCLUSIONS Current literature cannot confirm or exclude the risk for HBV/HCV transmission in nail salons and barbershops. Existing sanitary requirements are adequate in the majority of states, but compliance is needed to prevent HBV/HCV transmission in these businesses.
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Reed JR, Jordan AE, Perlman DC, Smith DJ, Hagan H. The HCV care continuum among people who use drugs: protocol for a systematic review and meta-analysis. Syst Rev 2016; 5:110. [PMID: 27401499 PMCID: PMC4940695 DOI: 10.1186/s13643-016-0293-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/17/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The diagnosis, management, and treatment for hepatitis C virus (HCV) infection (the "HCV care continuum") have improved in recent years. People who use drugs (PWUD) have a prevalence of HCV infection from 30 to 70 %, yet rates of testing, engagement in care, and treatment for HCV are disproportionately low compared to other populations. Delineating the progression of PWUD through the steps in the HCV care continuum in the USA is important in informing efforts to improve HCV outcomes among PWUD. METHODS/DESIGN Scientific databases will be searched using a comprehensive automated search strategy; gray literature and reference lists will be manually searched. Eligible reports will provide original research data related to the HCV care continuum in the USA including proportions of PWUD engaging in the following discrete steps: screening/testing, engagement in care (including receiving an HCV clinical assessment), treatment initiation and completion, and rates of those with successful HCV treatment. A quality-rating tool will be developed to ascertain the level of bias (including selection bias) in each report, and a quality score will be assigned to each eligible report. A tool adapted from the Pragmatic Explanatory Continuum Indicator Summary-2 instrument will be developed to assess the extent to which an included report reflects an effectiveness or efficacy study design. Pooled estimates and measures of association will be calculated using random effects models, and heterogeneity will be assessed at each stage of data synthesis. DISCUSSION Through this review, we hope to quantify the proportion of PWUD at each progressive step and to help identify key individual, social, and structural points of leakage in the HCV care continuum for PWUD. In meeting these objectives, we will identify predictors to progress along the HCV care continuum, which can be used to inform policy to directly improve HCV care for PWUD. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016034113.
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Affiliation(s)
- Jennifer R Reed
- College of Nursing, New York University, 422 First Avenue, New York, NY, 10010, USA.
| | - Ashly E Jordan
- College of Nursing, New York University, 422 First Avenue, New York, NY, 10010, USA.,Center for Drug Use and HIV Research, New York, NY, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, NY, USA.,Mount Sinai Beth Israel, New York, NY, USA
| | - Daniel J Smith
- College of Nursing, New York University, 422 First Avenue, New York, NY, 10010, USA
| | - Holly Hagan
- College of Nursing, New York University, 422 First Avenue, New York, NY, 10010, USA.,Center for Drug Use and HIV Research, New York, NY, USA
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Lewis CF, Rivera AV, Crawford ND, Gordon K, White K, Vlahov D, Galea S. Individual and Neighborhood Characteristics Associated with HIV Among Black and Latino Adults Who Use Drugs and Unaware of Their HIV-Positive Status, New York City, 2000-2004. J Racial Ethn Health Disparities 2015; 3:573-581. [PMID: 27294761 DOI: 10.1007/s40615-015-0176-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
With mounting evidence of how neighborhood socioeconomic context influences individual behavior, investigation of neighborhood social context and sex/drug use risk behavior could help explain and provide insight into solutions to solve persistent racial disparities in HIV. Interviewer-administered surveys and HIV testing among street-recruited individuals who reported illicit drug use in New York City were conducted from 2000 to 2004. Individuals were geocoded to census tracts, and generalized estimating equations were used to determine correlates of being newly diagnosed with HIV at study enrollment. Analyses were completed in 2014. Of the 920 participants, 10.5 % were HIV-positive, and among those, 45 % were diagnosed at study enrollment. After restricting the sample to those who self-reported negative HIV status (n = 867), 72 % were male, 65 % Latino, and 5.1 % tested HIV-positive. After adjustment, those testing HIV-positive were more likely to report male same-sex partnership (p < 0.01) and less likely to be homeless compared with those confirmed HIV-negative (p < 0.01). Neighborhood-adjusted models indicated those from neighborhoods with less deprivation (p < 0.05), and a higher proportion of owner-occupied homes (p < 0.01) were more likely to test HIV-positive. Additionally, Black individuals who used drugs and were from neighborhoods with a higher proportion of Black residents were more likely to be newly diagnosed compared to Latino individuals who used drugs and were from neighborhoods with lower proportions of Black residents (p < 0.05). These data suggest that HIV prevention and treatment efforts should continue widening its reach to those unaware of their HIV infection, namely men who have sex with men, heavy, drug-involved Black communities, and both Black and Latino communities from relatively less disadvantaged neighborhoods.
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Affiliation(s)
- Crystal Fuller Lewis
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, State of New York Office of Mental Health, 140 Orangeburg Road, Bldg. #35, N202, Orangeburg, NY, 10962, USA. .,Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - Alexis V Rivera
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Natalie D Crawford
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kirsha Gordon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kellee White
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - David Vlahov
- School of Nursing, University of California, San Francisco, CA, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Volpe GE, Ward H, Mwamburi M, Dinh D, Bhalchandra S, Wanke C, Kane AV. Associations of cocaine use and HIV infection with the intestinal microbiota, microbial translocation, and inflammation. J Stud Alcohol Drugs 2014; 75:347-57. [PMID: 24650829 DOI: 10.15288/jsad.2014.75.347] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE HIV and illicit drug use have been associated with altered nutrition, immune function, and metabolism. We hypothesized that altered composition and decreased diversity of the intestinal microbiota, along with microbial translocation, contribute to nutritional compromise in HIV-infected drug users. METHOD We enrolled 26 men and 6 women, 15 HIV infected and 17 HIV uninfected, in this exploratory, cross-sectional study; 7 HIV-infected and 7 HIV-uninfected participants had used cocaine within the previous month. We examined the independent effects of cocaine use and HIV infection on the composition and diversity of the intestinal microbiota, determined by 16S rRNA gene pyrosequencing. Using dietary records, anthropometrics, and dual x-ray absorptiometry, we examined the additional effects of nutritional indices on the intestinal microbiota. We compared markers of inflammation and microbial translocation between groups. RESULTS Cocaine users had a higher relative abundance of Bacteroidetes (M ± SD = 57.0% ± 21 vs. 37.1% ± 23, p = .02) than nonusers. HIV-infected individuals had a higher relative abundance of Proteobacteria (Mdn [interquartile range] = 1.56% [0.5, 2.2] vs. 0.36% [0.2, 0.7], p = .03), higher levels of soluble CD14 and tumor necrosis factor-α, and lower levels of anti-endotoxin core antibodies than uninfected subjects. HIV-infected cocaine users had higher interferon-γ levels than all other groups. Food insecurity was higher in HIV-infected cocaine users. CONCLUSIONS We identified differences in the relative abundance of major phyla of the intestinal microbiota, as well as markers of inflammation and microbial translocation, based on cocaine use and HIV infection. Nutritional factors, including alcohol use and lean body mass, may contribute to these differences.
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Affiliation(s)
- Gretchen E Volpe
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| | - Honorine Ward
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| | - Mkaya Mwamburi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Duy Dinh
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Seema Bhalchandra
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Christine Wanke
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| | - Anne V Kane
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
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Jozaghi E. A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada. Harm Reduct J 2014; 11:30. [PMID: 25395278 PMCID: PMC4251950 DOI: 10.1186/1477-7517-11-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. METHODS The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). RESULTS The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. CONCLUSIONS Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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18
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Alcohol misuse and illicit drug use are associated with HCV/HIV co-infection. Epidemiol Infect 2014; 142:2616-23. [DOI: 10.1017/s0950268814000041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
SUMMARYWe studied hepatitis C virus (HCV) prevalence and risk factors for HCV infection in a sample of Brazilian HIV-positive patients. A cross-sectional study was conducted with 580 HIV-positive patients from a specialized HIV/AIDS diagnosis and treatment centre in southern Brazil. All patients were interviewed for socio-demographic and risk factors and tested for HCV antibodies and HCV-RNA detection. A multivariate analysis was performed to identify risk factors for HCV infection. A total of 138 (24%) patients had past or chronic hepatitis C. The following risk factors were associated with HCV infection for each gender: alcohol misuse and injecting drug use in women (P < 0·001) and low educational level, smoking drug use, and injecting drug use in men (P < 0·01). These results suggest that alcohol misuse, low educational level, smoking drug use, and injecting drug use are probable risk factors for HCV infection in HIV-positive patients. This information contributes to an understanding of the epidemiology of HIV/HCV co-infection in Brazil.
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Ersche KD, Hagan CC, Smith DG, Abbott S, Jones PS, Apergis-Schoute AM, Döffinger R. Aberrant disgust responses and immune reactivity in cocaine-dependent men. Biol Psychiatry 2014; 75:140-7. [PMID: 24090796 PMCID: PMC3898808 DOI: 10.1016/j.biopsych.2013.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infectious diseases are the most common and cost-intensive health complications associated with drug addiction. There is wide belief that drug-dependent individuals expose themselves more regularly to disease-related pathogens through risky behaviors such as sharing pipes and needles, thereby increasing their risk for contracting an infectious disease. However, evidence is emerging indicating that not only lifestyle but also the immunomodulatory effects of addictive drugs, such as cocaine, may account for their high infection risk. As feelings of disgust are thought to be an important psychological mechanism in avoiding the exposure to pathogens, we sought to investigate behavioral, physiological, and immune responses to disgust-evoking cues in both cocaine-dependent and healthy men. METHODS All participants (N = 61) were exposed to neutral and disgust-evoking photographs depicting food and nonfood images while response accuracy, latency, and skin conductivity were recorded. Saliva samples were collected before and after exposure to neutral and disgusting images, respectively. Attitudes toward disgust and hygiene behaviors were assessed using questionnaire measures. RESULTS Response times to disgust-evoking photographs were prolonged in all participants, and specifically in cocaine-dependent individuals. While viewing the disgusting images, cocaine-dependent individuals exhibited aberrant skin conductivity and increased the secretion of the salivary cytokine interleukin-6 relative to control participants. CONCLUSION Our data provide evidence of a hypersensitivity to disgusting stimuli in cocaine-dependent individuals, possibly reflecting conditioned responses to noningestive sources of infection. Coupled with a lack of interoception of bodily signals, aberrant disgust responses might lead to increased infection susceptibility in affected individuals.
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Affiliation(s)
- Karen D Ersche
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Cindy C Hagan
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Dana G Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Sanja Abbott
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - P Simon Jones
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Annemieke M Apergis-Schoute
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Rainer Döffinger
- Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
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Reynolds GL, Fisher DG, Napper LE. Assessment of risky injection practices associated with hepatitis B, hepatitis C, and human immunodeficiency virus and using the blood-borne virus transmission risk assessment questionnaire. J Addict Dis 2012; 31:80-8. [PMID: 22356671 DOI: 10.1080/10550887.2011.642755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Risky injection practices among injection drug users (IDUs) contribute to the spread of blood-borne infections such as human immunodeficiency virus, hepatitis B, and hepatitis C. The Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ). was developed in Australia to determine risk behaviors for specific infections. Blood testing for human immunodeficiency virus, hepatitis B, and hepatitis C was performed on all participants, and data on blood tests were linked to questionnaires. The BBV-TRAQ was administered to 242 current and former injection drug users in Long Beach, California, and the Long Beach data were compared with the original Australian data. In the comparison of the mean scores on the three subscales and total scores on the BBV-TRAQ between the samples, means for all three subscales and the total BBV-TRAQ score were significantly different, with Long Beach scores consistently lower than the Australian sample. The injecting and sexual risk subscales were significantly different across levels of AIDS risk perception for all three types of injectors; however, the other skin penetration practices subscale had no significant association with AIDS risk perception for any of the injection drug user groups. Despite recent efforts to educate injectors about the risks associated with practices captured by the other skin penetration practices subscale, such as tattooing and sharing razors, this subscale does not have an association with AIDS risk perception. injection drug users in Australia may have better access to health care, giving their self-report of infection greater validity than the California sample.
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Affiliation(s)
- Grace L Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, California 90813, USA.
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21
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Hermanstyne KA, Bangsberg DR, Hennessey K, Weinbaum C, Hahn JA. The association between use of non-injection drug implements and hepatitis C virus antibody status in homeless and marginally housed persons in San Francisco. J Public Health (Oxf) 2012; 34:330-9. [PMID: 22451327 DOI: 10.1093/pubmed/fds018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Up to 17,000 persons in the USA became infected with hepatitis C virus (HCV) in 2007, and many cases have unknown transmission routes. To date research on transmission of HCV via shared implements used to snort or smoke non-injection drugs has been inconclusive. METHODS We tested stored sera for HCV antibodies (anti-HCV) in a large population-based study of homeless and marginally housed persons in San Francisco. We examined the association between sharing implements used for snorting and smoking drugs and anti-HCV while controlling for sociodemographic variables in those who denied ever injecting drugs (n = 430). We also examined the association of anti-HCV status with history of incarceration, tattoo and piercing history, sexual history and alcohol consumption. RESULTS Seventeen percent of our sample was anti-HCV positive. We found no statistically significant associations with sharing implements used to smoke or snort drugs with anti-HCV status in our various multivariate models. There was a statistically significant negative association between ever snorting cocaine and anti-HCV status (adjusted odds ratio: 0.39; 95% confidence interval: 0.21-0.73). There were no other statistically significant associations with any other measured covariates in multivariate analyses. CONCLUSIONS Our findings suggest that sharing implements to snort or smoke drugs is not a significant risk factor for anti-HCV-positive status.
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Affiliation(s)
- Keith A Hermanstyne
- Department of Psychiatry, University of California-San Francisco, 401 Parnassus Ave., Box 0984, San Francisco, CA 94143-0984, USA.
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Bravo MJ, Vallejo F, Barrio G, Brugal MT, Molist G, Pulido J, Sordo L, de la Fuente L. HCV seroconversion among never-injecting heroin users at baseline: no predictors identified other than starting injection. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:415-9. [PMID: 22421554 DOI: 10.1016/j.drugpo.2012.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heroin users who do not inject constitute a large pool of drug users with a potentially important impact on public health. We aimed to estimate the incidence of hepatitis C virus (HCV) among heroin users who had never injected (NIDUS) at baseline, and the effect of starting injecting during follow-up, other percutaneous exposures, sharing snorting paraphernalia, cocaine/crack use, and risky sexual behaviour on HCV-seroconversion. METHODS Prospective cohort of 305 HCV-negative NIDUs at baseline, aged 18-30 and street-recruited in three Spanish cities in 2001-2003. Computer-assisted personal interviews were conducted and dried blood-spot samples were collected. Bivariate and multivariable Poisson models were used. RESULTS Among the 305 never-injectors who were HCV-negative at baseline, 197 (64.6%) were followed-up and 21 seroconverted [HCV-incidence rate=5.8/100 person-years at risk (pyar) (95% CI: 3.6-8.9)]. HCV incidence in new-injectors was 28.4/100 pyar [(95% CI, 14.7-49.7) vs. 2.8/100 pyar (95% CI, 1.3-5.4)] among NIDUs. Of the risk exposures considered, starting injecting was the only predictor of HCV-seroconversion [adjusted relative risk=10.1, 95% CI: 3.8-26.7]. CONCLUSION The HCV-seroconversion rate was 10 times higher among new-injectors than never-injectors. No predictors other than starting injecting were found for HCV-seroconversion. Harm reduction interventions to prevent HCV infection should include prevention of drug injection.
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Affiliation(s)
- María J Bravo
- Centro Nacional De Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Vearrier D, Greenberg MI, Miller SN, Okaneku JT, Haggerty DA. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Dis Mon 2012; 58:38-89. [PMID: 22251899 DOI: 10.1016/j.disamonth.2011.09.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Tohme RA, Holmberg SD. Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clin Infect Dis 2012; 54:1167-78. [PMID: 22291098 DOI: 10.1093/cid/cir991] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Tattoos and piercings are increasing, especially among youths, but the risk of hepatitis C virus (HCV) infection from these practices has not been adequately assessed and there are conflicting findings in the literature. We evaluated the risk of HCV infection from tattooing and piercing using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies that specified the venue of tattooing and/or piercing showed no definitive evidence for an increased risk of HCV infection when tattoos and piercings were received in professional parlors. However, the risk of HCV infection is significant, especially among high-risk groups (adjusted odds ratio, 2.0-3.6), when tattoos are applied in prison settings or by friends. Prevention interventions are needed to avoid the transmission of hepatitis C from tattooing and piercing in prisons, homes, and other potentially nonsterile settings. Youths also should be educated on the need to have tattoos and piercings performed under sterile conditions to avoid HCV infection.
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Affiliation(s)
- Rania A Tohme
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Peña-Orellana M, Hernández-Viver A, Caraballo-Correa G, Albizu-García CE. Prevalence of HCV risk behaviors among prison inmates: tattooing and injection drug use. J Health Care Poor Underserved 2011; 22:962-82. [PMID: 21841290 DOI: 10.1353/hpu.2011.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hepatitis C virus (HCV) is the most common blood-borne chronic viral infection in the United States and it is over represented in incarcerated populations. This study estimates if in prison tattooing is associated with self reported HCV infection in a probabilistic sample of 1,331 sentenced inmates in Puerto Rico prisons anonymously surveyed in 2004, who had previously been tested for HCV. Analysis were carried out with the total sample and among non-injectors (n=796) to control for injection drug use (IDU) and other confounders. Nearly 60% of inmates had acquired tattoos in prison. HCV was reported by 27% of subjects in the total sample and by 12% of non-injectors who had undergone tattoos in prison. IDU was the strongest predictor of HCV in the total sample (OR=5.6, 95% CI=3.2-9.7). Among non injectors, tattooing with reused needles or sharp objects and/ or reusing ink was positively associated with HCV self-report (OR=2.6, 95% CI=1.3-5.5). Tattooing is a common occurrence in this prison setting. Findings suggest that preventive interventions are required to reduce the risk of HCV transmission through unsterile tattooing and injection practices.
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Affiliation(s)
- Marisol Peña-Orellana
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Rourke SB, Sobota M, Tucker R, Bekele T, Gibson K, Greene S, Price C, Koornstra JJ(J, Monette L, Byers S, Watson J, Hwang SW, Guenter D, Dunn J, Ahluwalia A, Wilson MG, Bacon J. Social determinants of health associated with hepatitis C co-infection among people living with HIV: results from the Positive Spaces, Healthy Places study. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2011; 5:e120-31. [PMID: 22046224 PMCID: PMC3205830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 03/09/2011] [Accepted: 03/13/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Social determinants of health (SDOH) may influence the probability of people living with HIV also being infected with hepatitis C virus (HCV). We compared the SDOH of adults co-infected with HCV/HIV with that of HIV mono-infected adults to identify factors independently associated with HCV infection. METHODS In this cross-sectional study, face-to-face interviews were conducted with 509 HIV-infected adults affiliated with or receiving services from community-based AIDS service organizations (CBAOs). The primary outcome measure was self-reported HCV infection status. Chi-square, Student's t tests, and Wilcoxon rank-sum tests were performed to compare SDOH of HCV/HIV co-infected participants with that of HIV mono-infected participants. Multivariable hierarchical logistic regression was used to identify factors independently associated with HCV co-infection. RESULTS Data on 482 (95 HCV/HIV co-infected and 387 HIV mono-infected) adults were analyzed. Compared with participants infected with HIV only, those who were co-infected with HIV and HCV were more likely to be heterosexual, Aboriginal, less educated and unemployed. They were more likely to have a low income, to not be receiving antiretroviral treatment, to live outside the Greater Toronto Area (GTA), to use/abuse substances, experience significant depression, and utilize addiction counselling and needle-exchange services. They also were more likely to report a history of homelessness and perceived housing-related discrimination and to have moved twice or more in the previous 12 months. Factors independently associated with HCV/HIV co-infection were history of incarceration (odds ratio [OR] 8.81, 95% CI 4.43-17.54), history of homelessness (OR 3.15, 95% CI 1.59-6.26), living outside of the GTA (OR 3.13, 95% CI 1.59-6.15), and using/abusing substances in the past 12 months (OR 2.05, 95% CI 1.07-3.91). CONCLUSION Differences in SDOH exist between HIV/HCV co-infected and HIV mono-infected adults. History of incarceration, history of homelessness, substance use, and living outside the GTA were independently associated with HCV/HIV co-infection. Interventions that reduce homelessness and incarceration may help prevent HCV infection in people living with HIV.
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Nurutdinova D, Abdallah AB, Bradford S, O'Leary CC, Cottler LB. Risk factors associated with Hepatitis C among female substance users enrolled in community-based HIV prevention studies. BMC Res Notes 2011; 4:126. [PMID: 21492467 PMCID: PMC3095996 DOI: 10.1186/1756-0500-4-126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 04/14/2011] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis C virus (HCV) infection is one of the most frequent chronic blood-borne infections in the United States. The epidemiology of HCV transmission is not completely understood, particularly in women and minorities. Findings We examined the HCV associated risk factors in substance abusing females involved in National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute on Drug Abuse (NIDA) funded HIV prevention studies of street recruited women. As a part of the 12 month follow-up, participants were interviewed about substance use and sexual risk behaviors, including drug implement sharing practices, tattoos, body piercing and blood transfusions and the sharing of personal hygiene equipment including tweezers, toothbrushes and razors. Urine and blood testing for HCV antibody (Ab), HIV and sexually transmitted diseases (STDs) was conducted at the time of assessment. Among 782 predominantly African American women, 162 (21%) tested positive for HCV Ab. Older age (p < 0.001), history of injection drug use (p < 0.001), lifetime crack cocaine use (p = 0.004) and having a tattoo (p = 0.01) were significantly associated with HCV Ab positivity. Other risk factors previously reported in association with HCV Ab positivity such as sexual risk behaviors were not significantly associated with the presence of a positive HCV Ab. Conclusions This large community based sample of predominantly African American substance abusing women showed high prevalence of HCV Ab positivity and low awareness of their HCV serostatus. Our study demonstrated that in addition to intravenous drug use (IDU), other factors were significantly associated with HCV Ab positivity such as having a tattoo and a lifetime history of crack use. Other potential routes of HCV transmission should be further studied among high risk female populations.
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Affiliation(s)
- Diana Nurutdinova
- St, Louis VA Medical Center, 915 North Grand Blvd, St, Louis, MO, 63106 USA.
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Caiaffa WT, Zocratto KF, Osimani ML, Martínez PL, Radulich G, Latorre L, Muzzio E, Segura M, Chiparelli H, Russi J, Rey J, Vazquez E, Cuchi P, Sosa-Estani S, Rossi D, Weissenbacher M. Hepatitis C virus among non-injecting cocaine users (NICUs) in South America: can injectors be a bridge? Addiction 2011; 106:143-51. [PMID: 20955486 DOI: 10.1111/j.1360-0443.2010.03118.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the factors associated with hepatitis C virus (HCV) infection among non-injecting cocaine users (NICUs) and to compare practices associated with HCV and HIV infection. DESIGN An intercountry cross-sectional study. Setting Buenos Aires and Montevideo metropolitan areas. PARTICIPANTS A total of 871 NICUs. MEASUREMENTS NICUs were interviewed and their blood was drawn and used for HCV, HIV, HBV surface antigen (HbsAg), HB-anticore and Venereal Disease Research Laboratory (VRDL) antibody assays. Bivariate and multivariate logistic regression analyses included comparisons of HCV and HIV mono-infected participants with HCV-HIV seronegatives. FINDINGS Prevalence rates were 8.8 [95% confidence interval (CI): 6.9-10.8) for HCV and 7.9 (95% CI: 6.1-9.7) for HIV. HCV-infected NICUs were twice as likely as HCV-HIV seronegatives to have shared straws for cocaine snorting or sniffing, even when adjusted for other variables. HCV prevalence rates ranged from 3.6% among NICUs who denied sharing straws and having had an injection drug user (IDU) or an HIV-positive sexual partner to 12.6% among participants who reported ever having shared straws or having had either an IDU- or HIV-positive sexual partner (χ(2) (trend) = 6.56, P = 0.01). CONCLUSIONS Non-injecting cocaine users from South America are vulnerable to multiple infections and HCV infection appears to occur through the sharing of straws. HCV infection is associated with intimate relationships with IDUs or HIV-seropositive partners, supporting the hypothesis that HCV risk may be due primarily to risk-taking behaviour associated with drugs in this population.
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Affiliation(s)
- Waleska T Caiaffa
- Belo Horizonte Observatory for Urban Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Zocratto KBF, Osimani ML, Peralta LM, Latorre L, Muzzio E, Segura M, Chiparelli H, Proietti FA, Rey J, Vazquez E, Cuchi P, Estani SS, Rossi D, Weissenbacher M, Caiaffa WT. Sexual behavior and HBV infection among noninjecting cocaine users (NICUs). Subst Use Misuse 2010; 45:2026-44. [PMID: 20438315 DOI: 10.3109/10826081003791965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim is to estimate HBV prevalence and the associated risks among noninjecting cocaine users (NICUs). In 2002-2003, a total of 824 NICUs from Buenos Aires (Argentina) and Montevideo (Uruguay) were interviewed using a structured questionnaire. Serologic tests were carried out for Human Immunodeficiency Virus (HIV), hepatitis B (HBV), syphilis, and others. The population was divided into two serologic groups: HBV-infected and seronegative group. Univariate and binary logistic model were developed. The results seem to indicate that, among NICUs, HBV is transmitted through sexual contact. Prevention measures, including vaccine, are needed in order to control and minimize risks. The study's limitations are noted.
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Risk behaviors for HCV- and HIV-seroprevalence among female crack users in Porto Alegre, Brazil. Arch Womens Ment Health 2010; 13:185-91. [PMID: 19760050 DOI: 10.1007/s00737-009-0089-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
Several studies have shown a high prevalence of HIV-seropositive status among crack users, though most refer to North American populations. Few studies evaluate HCV prevalence among female crack users. In addition, there is a particular lack of data about risk behaviors and HIV/HCV prevalence in this population around the world. In order to ascertain the HIV/HCV serostatus and associated risk behaviors for infection of female crack users of Porto Alegre, Brazil. A cross-sectional study of a convenience sample of 73 current female crack users was conducted. Subjects answered NIDA's Risk Behavior Assessment and an AIDS Information Questionnaire. In addition, blood was collected from subjects for HIV/HCV tests. The overall prevalence of HIV was 37.0%; HCV seroprevalence was 27.7%; of 15.1% the sample was co-infected with HIV and HCV. Four years of schooling or fewer (OR 4.72-CI 95%; 1.49-14.99) and having three or more HIV tests in one's lifetime (OR 4.26-CI 95% (1.29-14.04)) were associated with HIV infection (after multivariate logistic regression). The single greatest risk factor for HCV infection was having 4 years of schooling or fewer (OR 4.51-CI 95%; 1.18-17.27). We found a very high prevalence of HIV and HCV infection among female crack users, and low education was the most significant risk factor associated with both infections.
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31
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Stein MD, Herman DS, Anderson BJ. A trial to reduce hepatitis C seroincidence in drug users. J Addict Dis 2010; 28:389-98. [PMID: 20155608 DOI: 10.1080/10550880903183034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To test whether a four-session motivational intervention would reduce hepatitis C virus (HCV) seroincidence among injection and non-injection drug users compared to an assessment-only condition, we performed a randomized 24-month clinical trial. At baseline, 277 participants reported using heroin or cocaine at least three times weekly were HCV antibody negative, 65% were male and 46% were Caucasian and 39% reported having injected drugs. Of the 15 (5.4%) individuals who seroconverted, all reported injecting drugs either at baseline or during follow-up. Seroconversion rates did not differ significantly by treatment assignment (p =.79). The annual HCV incident rate was 8.20 (95% confidence interval [CI] = 4.76-14.13) for injectors and 0.74 (95% CI = 0.19-2.98) for non-injectors per 100 person-years. Significantly fewer participants in the intervention group initiated injection drug use behaviors (p =.009). This intervention was no more effective at reducing HCV seroconversion than assessment alone but did decrease injection initiation.
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Affiliation(s)
- Michael D Stein
- General Research Medicine, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA.
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32
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Lopes CLR, Teles SA, Espírito-Santo MP, Lampe E, Rodrigues FP, Motta-Castro ARC, Marinho TA, Reis NR, Silva AMC, Martins RMB. Prevalence, risk factors and genotypes of hepatitis C virus infection among drug users, Central-Western Brazil. Rev Saude Publica 2010; 43 Suppl 1:43-50. [PMID: 19669064 DOI: 10.1590/s0034-89102009000800008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 04/30/2009] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To estimate prevalence of hepatitis C virus (HCV) infection and identify risk factors associated and circulating HCV genotypes and subtypes. METHODS Study conducted including 691 drug users attending 26 charitable, private and public drug treatment centers in Goiânia and Campo Grande, central-western Brazil, between 2005 and 2006. Sociodemographic characteristics and risk factors for HCV infection were collected during interviews. Blood samples were tested for HCV antibodies (anti-HCV). Positive samples were submitted to HCV RNA detection by PCR with primers complementary to 5' NC and NS5B regions of viral genome and genotyped by line probe assay (LiPA) and direct nucleotide sequencing followed by phylogenetic analysis. The prevalence and odds ratio were calculated with 95% confidence intervals. Risk factors were first estimated in the univariate analysis (p<0.10) and then analyzed by hierarchical logistic regression. Statistical significance was assessed at a 5% significance level. RESULTS The prevalence of anti-HCV was 6.9% (95% CI: 5.2-9.2). The multivariate analysis of risk factors revealed that age over 30 years and injecting drug use were associated with HCV infection. HCV RNA was detected in 85.4% (41/48) of anti-HCV-positive samples. Thirty-three samples were genotyped as genotype 1 by LiPA, subtypes 1a (63.4%) and 1b (17.1%), and 8 samples (19.5%) were genotype 3, subtype 3a. The phylogenetic analysis of the NS5B region showed that 17 (68%), 5 (20%), and 3 (12%) samples were subtypes 1a, 3a, and 1b, respectively. CONCLUSIONS The results show a high prevalence of HCV infection and predominance of subtype 1a among drug users in Brazil. In addition, injecting drug use was a major risk factor associated with HCV infection.
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Affiliation(s)
- Carmen L R Lopes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, GO, Brasil
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Ferreira RC, Rodrigues FP, Teles SA, Lopes CLR, Motta-Castro ARC, Novais ACM, Souto FJD, Martins RMB. Prevalence of hepatitis B virus and risk factors in Brazilian non-injecting drug users. J Med Virol 2009; 81:602-9. [PMID: 19235862 DOI: 10.1002/jmv.21464] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Non-injecting drug users are at high-risk for acquiring hepatitis B virus (HBV), although the factors contributing to this increased risk are not known. In the present study, the overall and occult HBV infection prevalence rates were determined in a large population of non-injecting drug users in the Central-West region of Brazil. HBV genotypes and predictors of infection were also identified. A total of 852 individuals in 34 drug treatment centers were interviewed, and their serum samples were tested for the presence of HBV markers by ELISA. HBsAg and anti-HBc-positive samples were tested for HBV DNA by PCR. Samples with HBV DNA were genotyped by restriction fragment length polymorphism (RFLP). The overall prevalence of HBV infection was 14% (95% CI: 11.7-16.5). A multivariate analysis of risk factors showed that age >30 years, non-white race/ethnicity, duration of drug use >10 years, lifetime number of sexual partners >10, non-use of condoms, and HCV and HIV status were associated significantly with HBV infection. Of the 9 (1%) HBsAg-reactive samples, HBV DNA was present in 2/2 of HBeAg-positive and in 5/7 anti-HBe-positive samples. An occult HBV infection rate of 2.7% (3/110) was found among anti-HBc-positive individuals. All HBV DNA-positive samples were genotyped: seven were genotype A, two were genotype D, and one was genotype F. Finally, few individuals (8%) had serological evidence of a previous HBV vaccination. These findings indicate that preventive interventions are needed for both sexual and drug-related high-risk behavior. Additionally, non-injecting drug users should be targeted for HBV vaccination.
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Affiliation(s)
- Renata C Ferreira
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiás, Brazil
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34
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Rossi D, Radulich G, Muzzio E, Naveira J, Sosa-Estani S, Rey J, Griemberg G, Friedman SR, Martínez-Peralta L, Weissenbacher M. Multiple infections and associated risk factors among non-injecting cocaine users in Argentina. CAD SAUDE PUBLICA 2008; 24:965-74. [PMID: 18461225 DOI: 10.1590/s0102-311x2008000500003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 08/27/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to estimate the seroprevalence rates of human immunodeficiency virus (HIV), hepatitis B virus (HBV, core antibody), hepatitis C virus (HCV), and syphilis infections and analyze associated risk factors among 504 non-injecting cocaine users (NICU) in Buenos Aires, Argentina. Participants were interviewed in face-to-face sessions through a short structured questionnaire. Using venipuncture, 10 mL of blood was collected. Seroprevalence rates were: HIV (6.3%), HBV (9%), HCV (7.5%), and VDRL (4.2%). The risk of being infected with HIV, HBV, and HCV was significantly associated with having had a sex partner who was either a drug injector or who was known to be HIV positive. HIV and HCV infections were associated with former imprisonment, and HCV was associated with having been tattooed. Because of the rising number of NICU and the multiple infections detected, it is essential to implement prevention strategies focused on this population.
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Affiliation(s)
- Diana Rossi
- Intercambios: Asociación Civil para el Estudio y Atención de Problemas Relacionados con las Drogas, Avenida Corrientes 2548, Buenos Aires, Argentina.
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35
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Stern RK, Hagan H, Lelutiu-Weinberger C, Des Jarlais D, Scheinmann R, Strauss S, Pouget ER, Flom P. The HCV Synthesis Project: scope, methodology, and preliminary results. BMC Med Res Methodol 2008; 8:62. [PMID: 18789163 PMCID: PMC2546430 DOI: 10.1186/1471-2288-8-62] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 09/14/2008] [Indexed: 12/05/2022] Open
Abstract
Background The hepatitis C virus (HCV) is hyper-endemic in injecting drug users. There is also excess HCV among non-injection drug users who smoke, snort, or sniff heroin, cocaine, crack, or methamphetamine. Methods To summarize the research literature on HCV in drug users and identify gaps in knowledge, we conducted a synthesis of the relevant research carried out between 1989 and 2006. Using rigorous search methods, we identified and extracted data from published and unpublished reports of HCV among drug users. We designed a quality assurance system to ensure accuracy and consistency in all phases of the project. We also created a set of items to assess study design quality in each of the reports we included. Results We identified 629 reports containing HCV prevalence rates, incidence rates and/or genotype distribution among injecting or non-injecting drug user populations published between January 1989 and December 2006. The majority of reports were from Western Europe (41%), North America (26%), Asia (11%) and Australia/New Zealand (10%). We also identified reports from Eastern Europe, South America, the Middle East, and the Caribbean. The number of publications reporting HCV rates in drug users increased dramatically between 1989 and 2006 to 27–52 reports per year after 1998. Conclusion The data collection and quality assurance phases of the HCV Synthesis Project have been completed. Recommendations for future research on HCV in drug users have come out of our data collection phase. Future research reports can enhance their contributions to our understanding of HCV etiology by clearly defining their drug user participants with respect to type of drug and route of administration. Further, the use of standard reporting methods for risk factors would enable data to be combined across a larger set of studies; this is especially important for HCV seroconversion studies which suffer from small sample sizes and low power to examine risk factors.
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Affiliation(s)
- Rebecca K Stern
- Center for Drug Use and HIV Research, National Development and Research Institutes (NDRI), 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
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Macías J, Palacios RB, Claro E, Vargas J, Vergara S, Mira JA, Merchante N, Corzo JE, Pineda JA. High prevalence of hepatitis C virus infection among noninjecting drug users: association with sharing the inhalation implements of crack. Liver Int 2008; 28:781-6. [PMID: 18312289 DOI: 10.1111/j.1478-3231.2008.01688.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Most of the prevalent cases of hepatitis C virus (HCV) infection are attributable to intravenous drug using. However, a substantial number of individuals, particularly noninjecting drug users (NIDU), report no identifiable source of HCV exposure. This may be interpreted as inaccurate reporting of past intravenous exposure or as the presence of an unidentified source of HCV infection. Because of this, we evaluated the prevalence of and factors associated with HCV infection among NIDU. METHODS One hundred and eighty-two individuals who were attended from 2003 to 2004 in a drug addiction facility because of noninjecting drug use were included. RESULTS HCV infection was detected in 23 (12.6%) participants. Sharing the inhalation tube of crack cocaine [adjusted odds ratio (AOR) 3.6, 95% confidence interval (CI) 1.3-9.8, P=0.01], presence of tattoos (AOR 3.5, 95% CI 1.3-9.1, P=0.02) and age >or=34 years (AOR 3.9, 95% CI 1.3-11.6, P=0.01) 3.9 were independently associated with HCV infection. CONCLUSION The prevalence of HCV infection in NIDU is higher than in general population. HCV infection is more likely among older drug users, those with tattoos and crack cocaine users that share the inhalation implements.
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Affiliation(s)
- Juan Macías
- Servicio de Medicina Interna, Hospital Universitario de Valme, Seville, Spain.
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38
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Willner-Reid J, Belendiuk KA, Epstein DH, Schmittner J, Preston KL. Hepatitis C and human immunodeficiency virus risk behaviors in polydrug users on methadone maintenance. J Subst Abuse Treat 2008; 35:78-86. [PMID: 17931826 PMCID: PMC2600879 DOI: 10.1016/j.jsat.2007.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 07/11/2007] [Accepted: 08/08/2007] [Indexed: 11/22/2022]
Abstract
We examined the impact of methadone maintenance treatment (MMT) on risk behaviors for transmission of blood-borne diseases in polydrug users who had tested positive or negative for hepatitis C virus (HCV). At intake, HCV-positive participants (n=362) engaged in more human immunodeficiency virus (HIV) risk behaviors (as measured by the HIV Risk-Taking Behavior Scale) than HCV-negative participants (n=297; p< .001). This difference was specific to injection-related behaviors and decreased significantly within the first few weeks of MMT (p< .0001). Where needles continued to be used, HCV-positive participants became more likely over time to engage in safer injecting practices. Furthermore, HCV-positive participants became more likely to use condoms than HCV-negative participants. These findings demonstrate that both drug- and sex-related risk behaviors decrease during MMT and emphasize the benefits of methadone programs for public health and HIV/HCV prevention.
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Nyamathi A, Dixon EL, Shoptaw S, Marfisee M, Gelberg L, Williams S, Dominick S, Leake B. Profile of lifetime methamphetamine use among homeless adults in Los Angeles. Drug Alcohol Depend 2008; 92:277-81. [PMID: 17681434 PMCID: PMC2214821 DOI: 10.1016/j.drugalcdep.2007.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 06/15/2007] [Accepted: 06/25/2007] [Indexed: 10/23/2022]
Abstract
Although the dramatic rise of methamphetamine use in the general population has been well-documented, little is known about methamphetamine use in the homeless population. This study examines self-reported methamphetamine use and its correlates among a sample of 664 urban homeless adults in Los Angeles. Over one-quarter of the overall sample, and 60% of whites, disclosed lifetime methamphetamine use. Less than 10% of African-Americans reported ever using methamphetamine. Approximately one-tenth of respondents reported current methamphetamine use; almost 90% of current users shared straws to snort methamphetamine and half used it daily. Logistic regression analysis in younger (18-39) and older (40+) respondents revealed that white ethnicity, polydrug use and binge drinking were independently associated with lifetime methamphetamine use, regardless of age. Injection drug use (IDU) was also an important correlate of methamphetamine use for older African-Americans. IDU was not important for the younger group. Findings suggest that there is need for greater surveillance of methamphetamine use among homeless whites and Hispanics, and methamphetamine-use prevention and reduction targeted to younger, polydrug-using, alcohol-binging homeless adults.
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Affiliation(s)
- Adeline Nyamathi
- University of California, Los Angeles, School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, (310) 825-8405, phone, (310) 206-7433, fax,
| | - Elizabeth L. Dixon
- University of California, Los Angeles, School of Nursing, Room 5-942, Factor Building, Los Angeles, CA 90095, (310) 267-1823, phone, (310) 206-3241, fax,
| | - Steven Shoptaw
- University of California, Los Angeles, Family Medicine, Box 957087, 10880 Wilshire Blvd, Los Angeles, CA 90095-7087, (310) 794-0619, ext 225, phone, (310) 794-2808, fax,
| | - Mary Marfisee
- University of California, Los Angeles, Family Medicine, Box 957087, 1920 Colorado Avenue, Los Angeles, CA 90095-7087, (818) 947-4095, phone,
| | - Lillian Gelberg
- University of California, Los Angeles, Family Medicine, Box 957087, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90095-7087, (310) 794-6092, phone, (310) 794-6097, fax,
| | - Stephanie Williams
- 8508 Greenwell Springs Road, #91, Baton Rouge, LA 70814, (225) 927-0912, phone, (225) 775-3510, fax
| | - Stephanie Dominick
- University of California, Los Angeles, School of Nursing, Room 3-669, Factor Building, Los Angeles, CA 90095, (310) 825-9516, phone, (310) 267-0413, fax
| | - Barbara Leake
- University of California, Los Angeles, School of Nursing, Room 3-659, Factor Building, Los Angeles, CA 90095 (310) 825-9516, phone, (310) 267-0413, fax,
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Bacchetti P, Tien PC, Seaberg EC, O'Brien TR, Augenbraun MH, Kral AH, Busch MP, Edlin BR. Estimating past hepatitis C infection risk from reported risk factor histories: implications for imputing age of infection and modeling fibrosis progression. BMC Infect Dis 2007; 7:145. [PMID: 18070362 PMCID: PMC2238758 DOI: 10.1186/1471-2334-7-145] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 12/10/2007] [Indexed: 01/16/2023] Open
Abstract
Background Chronic hepatitis C virus infection is prevalent and often causes hepatic fibrosis, which can progress to cirrhosis and cause liver cancer or liver failure. Study of fibrosis progression often relies on imputing the time of infection, often as the reported age of first injection drug use. We sought to examine the accuracy of such imputation and implications for modeling factors that influence progression rates. Methods We analyzed cross-sectional data on hepatitis C antibody status and reported risk factor histories from two large studies, the Women's Interagency HIV Study and the Urban Health Study, using modern survival analysis methods for current status data to model past infection risk year by year. We compared fitted distributions of past infection risk to reported age of first injection drug use. Results Although injection drug use appeared to be a very strong risk factor, models for both studies showed that many subjects had considerable probability of having been infected substantially before or after their reported age of first injection drug use. Persons reporting younger age of first injection drug use were more likely to have been infected after, and persons reporting older age of first injection drug use were more likely to have been infected before. Conclusion In cross-sectional studies of fibrosis progression where date of HCV infection is estimated from risk factor histories, modern methods such as multiple imputation should be used to account for the substantial uncertainty about when infection occurred. The models presented here can provide the inputs needed by such methods. Using reported age of first injection drug use as the time of infection in studies of fibrosis progression is likely to produce a spuriously strong association of younger age of infection with slower rate of progression.
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Affiliation(s)
- Peter Bacchetti
- Box 0560, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA.
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Scheinmann R, Hagan H, Lelutiu-Weinberger C, Stern R, Des Jarlais DC, Flom PL, Strauss S. Non-injection drug use and Hepatitis C Virus: a systematic review. Drug Alcohol Depend 2007; 89:1-12. [PMID: 17174481 PMCID: PMC1892753 DOI: 10.1016/j.drugalcdep.2006.11.014] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 11/13/2006] [Accepted: 11/14/2006] [Indexed: 11/29/2022]
Abstract
This systematic review examined the evidence on the prevalence of the Hepatitis C Virus (HCV) in non-injecting drug users (NIDUs) who sniff, smoke or snort drugs such as heroin, cocaine, crack or methamphetamine. The search included studies published from January 1989 to January 2006. Twenty-eight eligible studies were identified and the prevalence of HCV in these NIDU populations ranged from 2.3 to 35.3%. There was substantial variation in study focus and in the quality of the NIDU data presented in the studies. The results of our systematic review suggested that there are important gaps in the research of HCV in NIDUs. We identified a problem of study focus; much of the research did not aim to study HCV in users of non-injection drugs. Instead, NIDUs were typically included as a secondary research concern, with a principal focus on the problem of transmission of HCV in IDU populations. Despite methodological issues, HCV prevalence in this population is much higher than in a non-drug using population, even though some IDUs might have inadvertently been included in the NIDU samples. These studies point to a real problem of HCV in NIDU populations, but the causal pathway to infection remains unclear.
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Affiliation(s)
- Roberta Scheinmann
- Center for Drug Use and HIV Research, National Development and Research Institutes (NDRI), 71 West 23rd Street, 8th Floor, New York, NY 10010, United States.
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Bastos FI, Caiaffa W, Rossi D, Vila M, Malta M. The children of mama coca: Coca, cocaine and the fate of harm reduction in South America. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:99-106. [PMID: 17689352 DOI: 10.1016/j.drugpo.2006.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 11/22/2006] [Indexed: 11/30/2022]
Abstract
The paper reviews the main findings from substance misuse research carried out over the last two decades in South America looking at the main initiatives aimed at reducing drug related harm and curbing the spread of HIV/AIDS and other sexually transmitted and blood-borne diseases. The current challenges faced by harm reduction in the region are analysed from the perspective of the history of coca and its different uses in South America. Except in Brazil and Argentina, the implementation of initiatives to reduce drug related harm in South America has been very cautious. The paper aims to link the analysis of harms associated with the use of illicit substances, with the often paradoxically harmful effects of supply-side drug policies in the world's largest coca/cocaine producing area. Despite the undeniable success of many initiatives, the broader context of harm maximization through structural violence and entrenched corruption acts as a major disincentive for the comprehensive adoption of sound public health policies.
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Benninghoff F, Morency P, Geense R, Huissoud T, Dubois-Arber F. Health trends among drug users attending needle exchange programmes in Switzerland (1994–2000). AIDS Care 2007; 18:371-5. [PMID: 16809115 DOI: 10.1080/09540120500429018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
As a part of an assessment of the Swiss drug harm-reduction policy, cross-sectional surveys were conducted in 1994, 1996 and 2000 among attenders of all needle exchange programmes (NEP) in Switzerland to assess changes in specific aspects of their health related to drug use. Data were gathered in each NEP over one week, using a questionnaire completed partly with an interviewer and partly self administered. The questionnaire covered socio-demographic characteristics, drug consumption, risk, prevention behaviour and state of health. Over a 6-year period (1994-2000), the average age of NEP attenders rose by 4 years. The prevalence of reported HIV remained fairly stable at around 10%. Reported level of Hepatitis C prevalence was high (59%). Incidence of used injection equipment sharing during the last 6 months was low and stable (9% in 1994, 12% in 2000); however, other forms of risk behaviour linked to intravenous drug use, such as sharing spoons, cotton or water, were more frequently reported. The HIV epidemic among NEP attenders seems to be contained, but this is not the case with Hepatitis C, and more attention should be paid to its prevention.
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Affiliation(s)
- F Benninghoff
- University Institute for Social and Preventive Medicine, Lausanne, Switzerland
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Des Jarlais DC, Arasteh K, Perlis T, Hagan H, Abdul-Quader A, Heckathorn DD, McKnight C, Bramson H, Nemeth C, Torian LV, Friedman SR. Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City. AIDS 2007; 21:231-5. [PMID: 17197815 DOI: 10.1097/qad.0b013e3280114a15] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare HIV prevalence among injecting and non-injecting heroin and cocaine users in New York City. As HIV is efficiently transmitted through the sharing of drug-injecting equipment, HIV infection has historically been higher among injecting drug users. DESIGN Two separate cross-sectional surveys, both with HIV counseling and testing and drug use and HIV risk behavior questionnaires. METHODS Injecting and non-injecting heroin and cocaine users recruited at detoxification and methadone maintenance treatment from 2001-2004 (n = 2121) and recruited through respondent-driven sampling from a research storefront in 2004 (n = 448). RESULTS In both studies, HIV prevalence was nearly identical among current injectors (injected in the last 6 months) and heroin and cocaine users who had never injected: 13% [95% confidence interval (CI), 12-15%] among current injectors and 12% (95% CI, 9-16%) among never-injectors in the drug treatment program study, and 15% (95% CI, 11-19%) among current injectors and 17% (95% CI, 12-21%) among never injectors in the respondent driven sampling storefront study. The 95% CIs overlapped in all gender and race/ethnicity subgroup comparisons of HIV prevalence in both studies. CONCLUSIONS The very large HIV epidemic among drug users in New York City appears to be entering a new phase, in which sexual transmission is of increasing importance. Additional prevention programs are needed to address this transition.
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Gonzales R, Marinelli-Casey P, Shoptaw S, Ang A, Rawson RA. Hepatitis C virus infection among methamphetamine-dependent individuals in outpatient treatment. J Subst Abuse Treat 2006; 31:195-202. [PMID: 16919748 DOI: 10.1016/j.jsat.2006.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 03/27/2006] [Accepted: 04/17/2006] [Indexed: 12/12/2022]
Abstract
Research on the relationship between illicit drug use and infectious diseases have primarily focused on the major problem of heroin injection and HIV transmission. Over the past decade, however, research have shown that rates of hepatitis C infection among injection drug users have surpassed those of HIV infection. There has been little systematic study on the relationship between hepatitis C virus (HCV) and the role of methamphetamine (MA) use in the transmission of the virus. This study examined the prevalence of hepatitis C infection among a sample of 723 MA-dependent individuals who sought outpatient treatment from 1999 through 2005. Roughly 15% of the total sample and 44% of the injectors were found to be infected with HCV. Controlling for participant characteristics, we found through multiple logistic regression analyses that HCV infection was more associated with injection use, older age, and female sex. Findings suggest a need for targeted education and prevention efforts about hepatitis C among high-risk MA users, including HCV testing coupled with referrals to HCV treatments.
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Affiliation(s)
- Rachel Gonzales
- UCLA Integrated Substance Abuse Programs, Los Angeles, CA 90025-7535, USA.
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Abstract
OBJECTIVE To describe the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the associated risk factors in a prison population. MATERIAL AND METHODS In this cross-sectional study, from November 2004 to February 2005, all 297 newly sentenced prisoners (mean age 37.5+/-11.7 years, age range 16-69 years), who had never used illicit drugs received routine blood check-ups and completed a face-to-face interview. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies were tested using the t-test, chi-square test, and logistic regression. RESULTS Among the 297 subjects, 13.1% were positive for HBsAg, 8.4% were positive for anti-HCV, and 1.7% were positive for combined HBsAg and anti-HCV. Logistic regression analysis demonstrated that tattooing (odds ratio=2.24, 95% CI=1.03-4.88) and an elevated alanine aminotransferase (ALAT) level (odds ratio=4.10, 95% CI=1.61-10.40) were independently related to HCV infection. CONCLUSIONS Screening of HBV and HCV infection in prison populations remains necessary. Tattooing and elevated ALAT level are identified as the related factors of HCV infection.
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Affiliation(s)
- Kuan-Fu Liao
- Department of Internal Medicine, Taichung Prison, and Department of Surgery, China Medical University Hospital, Taiwan
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Cohen DE, Russell CJ, Golub SA, Mayer KH. Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior. AIDS Patient Care STDS 2006; 20:557-64. [PMID: 16893325 DOI: 10.1089/apc.2006.20.557] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The present study sought to investigate the prevalence of hepatitis C virus (HCV) among men who have sex with men (MSM) seen at a community health center, and to examine risk factors associated with infection. The study population included 218 MSM who were screened for HCV infection during routine clinic visits from May through December, 2001. Eighty-four percent of those screened (n = 183) agreed to complete a self-report questionnaire assessing drug use, sexual practices, and medical history. Participants ranged in age from 22 to 54 years. The majority of participants (82%) self-identified as Caucasian and 35% were HIV-positive. Prevalence of HCV infection was 11.5%. Men infected with HCV were more likely than HCV uninfected men to be coinfected with HIV and hepatitis B, and to have a history of rectal or urethral gonorrhea. HCV-infected men were more likely to have seen blood on shared cocaine straws and to have used crack cocaine in the past 6 months. Overall, 12% of HCV-infected men reported no parenteral risk factors for HCV infection. HCV seropositivity was significantly associated with an aggregate score representing high-risk behavior in the past six months. HCV prevention and screening should target MSM engaging in high-risk sex. Conversely, HIV and sexually transmitted infection risk reduction interventions should be targeted at MSM with HCV.
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Affiliation(s)
- Daniel E Cohen
- Fenway Community Health, Boston, 7 Haviland Street, Massachusetts 02115, USA.
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