TO CREATE (Options in Health Care and Education)



Hepatitis IDU abstracts from CDC (Steve Jones)


This is a topical group of abstracts on drug use/IDUs added to NLM database between Dec 01 and May 02 Some individual abstracts are included in several topical groups. steve jones -------------------------------------- Ruzibakiev R. Kato H. Ueda R. Yuldasheva N. Hegay T. Avazova D. Kurbanov F. Zalalieva M. Tuichiev L. Achundjanov B. Mizokami M. Risk factors and seroprevalence of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection in Uzbekistan Intervirology. 44(6):327-332, 2001 Nov-Dec. Abstract Objectives: The aim of this study was to elucidate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection in Uzbekistan and to explore whether there is a correlation between those blood-borne agents and socioeconomic risk factors. Methods: One thousand nine hundred and eighteen subjects were studied. The subjects were divided into a low-risk group, a high-risk group and a patient group. Sera were tested for HBV surface antigen (HBsAg), anti-HCV, and anti-HIV. Results: The seroprevalence of HBsAg, anti-HCV, and anti-HIV in the general population was 13.3, 13.1 and 0%, respectively. The anti-HCV infection rate was significantly higher in intravenous drug users (62.7%) than in prostitutes (9.2%), homosexuals (11.1%), and medical laboratory employees (12.5%) (p<0.01). In the low-risk group, positivity for anti-HCV increased with age from 2.2% in the 15- to 20-year-olds up to the highest rate of 17.6% in the 31- to 40-year-olds; the positivity then decreased to 0% in the group over 60 years of age. In the high-risk group, the positivity for anti-HCV in the age groups under 40 years was approximately 30% and significantly higher than in the low-risk group (p<0.01). Risk factors for transmission of HCV were medical treatment in the low-risk group, drug abuse in the high-risk group, and both in the patient group. Conclusions: This study demonstrates that the seroprevalence of HBV and HCV infection is high, whereas HIV infection is yet uncommon in Uzbekistan. Copyright (C) 2002 S. Karger AG, Basel. [References: 21] -------------------- O'Donovan D. Cooke RPD. Joce R. Eastbury A. Waite J. Stene-Johansen K. An outbreak of hepatitis A amongst injecting drug users Epidemiology & Infection. 127(3):469-473, 2001 Dec. . Abstract This descriptive study investigated an outbreak of hepatitis A virus (HAV) infection among injecting drug users (IDUs) and their contacts. Twenty-seven cases of acute HAV infection were identified in a 5-month period. Connections with the local injecting drug using (IDU) population were established for 25 of the cases of whom 14 admitted to injecting drug use. HAV RNA genotyping revealed two HAV variants, closely related to variants found in Scandinavian IDUs and in South East Asia. The study demonstrates that once HAV enters the IDU population extensive outbreaks are possible. We recommend that all IDUs should be tested for HAV and hepatitis B virus (HBV) infections and offered combined hepatitis A and B vaccines if non-immune. [References: 37] ------------ Samuel MC. Doherty PM. Bulterys M. Jenison SA. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA Epidemiology & Infection. 127(3):475-484, 2001 Dec. Abstract This study aimed to assess the seroprevalence and risk factors for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV-1 infections among injecting drug users (IDU) in New Mexico. Serological and behavioural surveys were conducted in conjunction with street-based outreach, education and HIV counselling and testing. High rates of antibody positivity for HCV (82.2%) and HBV (61.1%), and a low rate for HIV (0.5%) were found. In multivariate analyses, both HBV and HCV infection were positively associated with increasing age, increasing years of injection and heroin use. Receipt of a tattoo in prison/jail was associated with HBV (odds ratio = 2.3, 95% confidence interval 1.4. 3.8) and HCV (OR = 3.4, 95% CI = 1.6, 7.5) infections. Prevention of bloodborne pathogens among IDUs should focus on young users, early in their drug use experience. Studies examining the relationship between tattooing and HBV and HCV infection are needed as are efforts to promote sterile tattooing, in prisons and elsewhere. [References: 43] --------------- Bourliere M. Barberin JM. Rotily M. Guagliardo V. Portal I. Lecomte L. Benali S. Boustiere C. Perrier H. Jullien M. Lambot G. Loyer R. LeBars O. Daniel R. Khiri H. Halfon P. Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users Journal of Viral Hepatitis. 9(1):62-70, 2002 Jan. . Abstract Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection, We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-cast of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly front the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P<0.01) and after 1990 (OR: 1.98, P<0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P<0.001) and has decreased since 1978 (OR: 0.27. P<0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P<0.001) and tattooing (OR: 8.01, P<0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P<0.001 and P<0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population. [References: 44] ---------------- Conti S. Masocco M. Pezzotti P. Toccaceli V. Vichi M. Crialesi T. Frova L. Rezza G. Excess mortality from liver disease and other non-AIDS-related diseases among HIV-infected individuals in Italy Journal of Acquired Immune Deficiency Syndromes. 29(1):105-107, 2002 Jan 1. ------------ Dalgard O. Bjoro K. Hellum K. Myrvang B. Skaug K. Gutigard B. Bell H. Treatment of chronic hepatitis C in injecting drug users: 5 years' follow-up European Addiction Research. 8(1):45-49, 2002 Jan. Abstract Aim of the Study, To assess the long-term hepatitis C (HCV) treatment outcome in former injecting drug users (IDUs). Materials and Methods: A long-term follow-up of 27 former IDUs who had been successfully treated for chronic hepatitis C was performed. These patients represented all IDUs who had obtained a sustained virological response in a Norwegian HCV treatment trial. The patients had been treated with interferon-a alone or in combination with ribavirin. At 5 years' follow-up the 27 IDUs were retested for HCV RNA and risk behaviour for HCV transmission after treatment was assessed. In the control group all 18 non-IDUs who had obtained a sustained virological response in the same treatment trial were included. Results: At follow-up 13-82 months (median 64) after the end of treatment only one case of probable reinfection was seen among the 27 IUDs. No reoccurrence of HCV was observed in the control group. The IDU who was HCV RNA positive at follow-up had continued injecting drugs and reported frequent needle sharing. At follow-up HCV of genotype la was detected in contrast to genotype 1b before treatment indicating that this patient was reinfected with HCV. A return to injecting drug use occurred in 9 (33%) of 27 IDUs. Conclusion: The long-term outcome of HCV treatment in former IDUs was excellent. Despite frequent reinitiation of drug injection all but 1 remained HCV RNA negative. Copyright (C) 2002 S. ------------- Di Martino V. Thevenot T. Boyer N. Cazals-Hatem D. Degott C. Valla D. Marcellin P. HIV coinfection does not compromise liver histological response to interferon therapy in patients with chronic hepatitis C AIDS. 16(3):441-445, 2002 Feb 15. Abstract Objective: Although discrepancies between histological and virological responses to anti-hepatitis C virus (HCV) therapy are well-established in HIV-negative patients, the liver histological outcome has never been assessed in HIV-HCV co-infected patients receiving anti-HCV therapy. We compared histological responses to interferon (IFN) alpha therapy between HIV-positive and HIV-negative injecting drug users (IDU) and determined factors associated with histological response. Design: Retrospective cohort study. Setting: Hepatology unit of a tertiary referral hospital. Patients/interventions: Seventy-nine HCV-infected IDU (32 HIV-positive) receiving a 6-month course of IFN-alpha2b therapy, 3 X 10(6) U three times a week. Primary outcome measure: Histological response, defined by a greater than or equal to 2 point decrease in total Knodell score measured on paired liver biopsies over a 2-year follow-up period. Results: The sustained response rate to IFN therapy was lower in HIV-positive patients than in HIV-negative patients (6.2% versus 29.8%; P=0.012). Conversely, the rates of histological response (40.6% versus 36.2%) were not different between HIV-positive and HIV-negative patients. Independent factors associated with histological response were first total Knodell score (P=0.0007) and sustained response to IFN therapy (odds ratio, 12.34; P=0.005). Histological response was observed in 25% of IFN non-responders whatever their HIV status. In HIV-positive patients, the CD4 cell count did not influence the histological response. Conclusions: in HIV-HCV co-infected patients treated with IFN, liver histological improvement is frequently observed, similarly to that observed in HIV-negative patients. Such beneficial effect of interferon therapy supports early treatment of chronic hepatitis C in HIV-infected patients. (C) 2002 Lippincott Williams Wilkins. [References: 25] ---------------------- Murrill CS. Weeks H. Castrucci BC. Weinstock HS. Bell BP. Spruill C. Gwinn M. Age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus infection among injection drug users admitted to drug treatment in 6 US cities American Journal of Public Health. 92(3):385-387, 2002 Mar. Abstract Objectives. This study measured age-specific seroprevalence of HIV, hepatitis 3 virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities. Methods. Remnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc). Results. Prevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West. Conclusions. The need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs. ------------------------ Conti S. Masocco M. Pezzotti P. Toccaceli V. Vichi M. Crialesi T. Frova L. Rezza G. Excess mortality from liver disease and other non-AIDS-related diseases among HIV-infected individuals in Italy Journal of Acquired Immune Deficiency Syndromes. 29(1):105-107, 2002 Jan 1. ---------------- Bourliere M. Barberin JM. Rotily M. Guagliardo V. Portal I. Lecomte L. Benali S. Boustiere C. Perrier H. Jullien M. Lambot G. Loyer R. LeBars O. Daniel R. Khiri H. Halfon P. Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users Journal of Viral Hepatitis. 9(1):62-70, 2002 Jan. Abstract Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection, We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-cast of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly front the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P<0.01) and after 1990 (OR: 1.98, P<0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P<0.001) and has decreased since 1978 (OR: 0.27. P<0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P<0.001) and tattooing (OR: 8.01, P<0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P<0.001 and P<0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population. ------------------------ Zhang CY. Yang RG. Xia XS. Qin SY. Dai JP. Zhang ZB. Peng ZZ. Wei T. Liu H. Pu DC. Luo JH. Takebe T. Ben KL. High prevalence of HIV-1 and hepatitis C virus coinfection among injection drug users in the southeastern region of Yunnan, China Journal of Acquired Immune Deficiency Syndromes. 29(2):191-196, 2002 Feb1. Abstract The southeastern region of Yunnan province is a key site for drug trafficking and HIV-1 infection spread from the west of Yunnan and Laos to southeastern China. To investigate the prevalence of HIV-1 infection and hepatitis C virus (HCV) coinfection among injection drug users (IDUs) in southeastern Yunnan, three cohorts of 285 addicts, including 242 IDUs and 43 oral drug users, living in the cities of Gejiu and Kaiyuan and the county of Yanshan were studied. HIV-1 and HCV infections were detected by enzyme-linked immunosorbent assay and/or polymerase chain reaction. Data on the age, sex, risk behavior, drug use history, employment, ethnic background, and marriage status were obtained by interview. The overall prevalence of HIV-1 infection was 71.9%. The rate of HCV coinfection among 138 HIV-1-infected IDUs was 99.3%. Most HIV-infected IDUs were 20 to 35 years old (86.7%) and were ethnic Han (75.9%), suggesting that the epidemic in Yunnan is no longer confined to non-Han ethnic minorities, HIV prevalence in female IDUs (81.2%) was significantly higher than in male IDUs (68.2%) (p <.05). The prevalence of HIV infection reached 68.4% after 1 year of injection drug use. Needle/syringe sharing is the major high risk factor for the spread of HIV-1 and HCV infections. Large-scale educational campaigns are urgently needed to reduce the spread of HIV and HCV infection in these regions. ----------------- Hernandez-Aguado I. Ramos-Rincon JM. Avino MJ. Gonzalez-Aracil J. Perez-Hoyos S. de la Hera MG. Ruiz-Perez I. Measures to reduce HIV infection have not been successful to reduce the prevalence of HCV in intravenous drug users European Journal of Epidemiology. 17(6):539-544, 2001. Abstract The objective of the study was to determine whether measures taken to prevent human immunodeficiency virus (HIV) infection also lead to a reduction in the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDU). Antibodies to HCV, HIV and hepatitis B virus (HBV) were determined in IDU who voluntarily attended AIDS prevention and information centres for the first time between 1990 and 1996. Of the 5473 IDU studied, determination of HCV was done in 3238 cases. The prevalence of antibodies to HCV was 85%. During the first period studied (1990-1992), the prevalence of antibodies to HCV was 84.5%, during the second (1993-1994) 84.1% and during the third (1995-1996) 87%; in the case of HBV the prevalence during the three periods was 74.5, 67.6 and 66.8% respectively, and for HIV it was 41.9, 38.8 and 36.6% respectively (RR: 0.72; 95% confidence interval (CI): 0.65-0.81). Among drug users addicted for less than 2 years, the trend of the prevalence of antibodies to HCV and HBV remained constant, while the prevalence of HIV infection decreased (RR: 0.61; 95% CI: 0.42-0.89). Measures to prevent transmission of HIV in drug users do not lead to a reduction in the prevalence of HCV infection. Further study is necessary to obtain a better understanding of how HCV is transmitted among drug users in order to apply measures which are effective in preventing HCV infection. [References: 32] ----------------------- Marine-Barjoan E. Fontas E. Pradier C. Ouzan D. Saint-Paul MC. Sattonnet C. Delasalle P. Boulant J. Gueyffier C. Varini JP. Bianchi D. Longo F. Michiels JF. Dellamonica P. Rampal P. Tran A. Registry of liver biopsies from hepatitis C infected patients in the Alpes-Maritimes (France). Results from the first 2 years [French] Gastroenterologie Clinique et Biologique. 26(1):57-61, 2002 Jan. Abstract Objective - To perform a descriptive analysis of patients with chronic hepatitis C based on a local registry of liver biopsies. Patients and method - Collection of clinical, biological and histological data from all HCV-infected patients who underwent liver biopsy between January 1997 and December 1998 in the Alpes-Maritimes (France). Results - One thousand and fifty six patients including 924 who lived in the Alpes-Maritimes (515 male, 409 female, mean age: 449 years aid) were included. Intravenous cl use (30.1%) was the mal. or suspected source of infection before blood transfusion (28.2%). Among intravenous drug users, 38% of patients were infected with genotype 1a and 37.4% with genotype 3. The META VIR Fibrosis severity score was distributed as follows: F0: 10.8%, F1: 53.7%, F2: 15.9%, F3: 14.7%, and F4: 4.9%. In a multivariate analysis adjusted for the duration of infection, independent risk factors associated with the severity of fibrosis were age at contamination greater than or equal to 30 years, genotype other than 1a and alcohol intake greater than or equal to 50 g/day. Determination of HCV antibody and liver biopsy were performed an average of 12.5 and 14 years after presumed date of contamination, respectively. Conclusions - These data provide a clearer view of the impact of this condition in this area and could help to define a comprehensive policy for patient management. ================== Fontana RJ. Hussain KB. Schwartz SM. Moyer CA. Su GL. Lok ASF. Emotional distress in chronic hepatitis C patients not receiving antiviral therapy Journal of Hepatology. 36(3):401-407, 2002 Mar. Abstract Background/Aims: The aim of our study was to determine the prevalence, type, and severity of emotional distress in a large group of consecutive chronic hepatitis C (CHC) patients not receiving anti-viral therapy. Methods: The brief symptom inventory and a 67-item questionnaire with the SF-36 embedded within it were used to study 220 outpatients with compensated CHC. Results: Seventy-seven (35%) participants reported significantly elevated global severity index (GSI) T-scores compared to an expected frequency of 10% in population controls. In addition, significantly elevated depression, anxiety, somatization, psychoticism, and obsessive-compulsive subscale T-scores were reported in 28-40% of subjects. Subjects with an active psychiatric co-morbidity had significantly higher GSI and subscale T-scores compared to subjects with active medical co-morbidities and subjects without medical or psychiatric co-morbidities (P < 0.01). However, patients with CHC alone also had a higher frequency of elevated GSI T-scores compared to population controls (20 versus 10%). GSI and subscale T-scores were strongly associated with SF-36 summary scores (P < 0.001). Conclusions: Clinically significant emotional distress was reported in 35% of CHC patients not receiving antiviral therapy. In addition to depression, a broad array of psychological symptoms were observed. Further investigation into the etiopathogenesis and treatment of emotional distress in CHC patients is warranted. (C) 2002 European Association for the Study of the Liver. ==================== Thorpe LE. Ouellet LJ. Hershow R. Bailey SL. Williams IT. Williamson J. Monterroso ER. Garfein RS. Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment American Journal of Epidemiology. 155(7):645-653, 2002 Apr 1. Abstract Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs. http://www.aje.oupjournals.org/cgi/content/full/155/7/645 --------------------- Rotily M. Loubiere S. Prudhomme J. Portal I. Tran A. Hofliger P. Valla D. Moatti JP. Factors related to screening hepatitis C virus in general medicine Gastroenterologie Clinique et Biologique. 26(3):261-269, 2002 Mar. Abstract Despite the high prevalence of hepatitis C in France (approximate to1.2%), a large proportion of people infected with hepatitis C virus (HCV) are not known aware of their status. The objective of this study was to investigate the factors related to screening in general medicine, Material and methods - Three hundred and one general practitioners were interviewed by phone in South-Eastern France about their HCV screening practices, knowledge of the epidemic, of the natural course of the disease, and opinions about health care for people infected with HCV. Results - While general practitioners often offered HCV screening to intravenous drug users, screening for people who had received blood transfusion, and identification of risk factors among patients were not satisfactory, Multivariate analysis showed that certain characteristics in general practitioners were negatively and independently related to the frequency of HCV screening, especially: general practitioners older than 40 (odds-ratio: 3,12), general practitioners who did not care for intravenous drug users (odds-ratio: 2.2,4)and did not prescribe human immunodeficiency virus tests (odds-ratio: 5.55). Other characteristics such as awareness of the course of hepatitis C and health care were also associated with HCV screening. Conversely knowledge of the size of the epidemic was not related to better HCV screening practices. Conclusion - Our study shows that knowledge about the size of the epidemic and the natural history of hepatitis C, HCV screening practices and investigation of risk factors among patients are not satisfactory among South-eastern French general practitioners. Although HCV screening and health care must be improved among intravenous drug users, hepatitis C should not be considered as a disease of injecting drug users only by general practitioners and the population, Efforts should be made so that hepatitis C is recognized as a global public health issue, and training of general practitioners should be improved to investigate risk factors and offer HCV screening instead of merely dramatizing the situation. ---------------- Rai R. Wilson LE. Astemborski J. Anania F. Torbenson N. Spoler C. Vlahov D. Strathdee SA. Boitnott J. Nelson KE. Thomas DL. Severity and correlates of liver disease in hepatitis C virus-infected injection drug users Hepatology. 35(5):1247-1255, 2002 May. Abstract Between May 1996 and June 1998, 210 members of a cohort of 1,667 hepatitis C virus (HCV)-infected injection drug users (IDUs) were selected for liver biopsy procedure after stratification based on 2 consecutive serum alanine transaminase (ALT) levels. Liver histology, which could be fully evaluated for 207 subjects, was classified by using the modified Ishak scores. At the time of biopsy, the median age of subjects was 41.3 years and the median estimated duration of HCV infection was 20.7 years; 94% were African American; 78% men; 31% were human immunodeficiency virus (HIV) seropositive; and 76% had HCV genotype la or 1b. Total modified histologic activity index (MHAI) scores ranged from 0 to 9, and 26.6% had a total MHAI score of 5 or greater. Persons with a total MHAI score of 5 or greater were more likely to be HIV infected (P = .04). Higher fibrosis, indicated by Ishak modified fibrosis scores of 3 to 6, was present in 10.1% of subjects and was found more often in those older than 46 years of age (the highest quartile) (P < .01). Both fibrosis scores of 3 or greater and total scores of 5 or greater were associated with elevated ALT, aspartate transaminase (AST), and gamma-glutamyl transpeptidase (GGT) levels (P < .01). When serial values were considered, the results of liver enzyme testing could reduce the probability of an IDU having a fibrosis score of 3 or greater from 10% to 3%. In conclusion, these data indicate that severe liver disease is uncommon in this urban, HCV-infected IDU cohort, especially in younger persons and those with repeatedly normal liver enzymes. -------------------- Mehta SH. Cox A. Hoover DR. Wang XH. Mao Q. Ray S. Strathdee SA. Vlahov D. Thomas DL. Protection against persistence of hepatitis C Lancet. 359(9316):1478-1483, 2002 Apr 27. Abstract Background Neither previous hepatitis C virus (HCV) infection nor vaccination with HCV-derived antigens protects against reinfection. However, HCV infection and vaccination in chimpanzees has been shown to reduce the magnitude and duration of viraemia with re-challenge. We aimed to establish whether similar immunity could be achieved in man. Methods From a study of injecting drug users, we identified 164 people who had no evidence of previous HCV infection and 98 individuals who had been previously, but were not currently, infected with HCV. We compared the incidence and persistence of HCV viraemia in these two groups over four consecutive 6-month periods. Findings Of participants without previous infection, the incidence of HCV infection was 21% (35/164). By contrast, people previously infected were half as likely to develop new viraemia (12% [12/98]), even after accounting for risk behaviour (hazard ratio, 0.45: 95% CI 0.23-0.88). Furthermore, in HIV-1-negative people, those previously infected were 12 times less likely than people infected for the first time to develop persistent infection (odds ratio 0.05, 95% CI 0.01-0.30), and median peak HCV RNA concentration was two logs lower. HCV persisted in six of six HIV-1-positive people, even in one man who had previously cleared HCV infection when he was HIV-1 negative. Interpretation There is an alarming frequency of HCV infection and persistence among injecting drug users. Our data suggest that immunity against viral persistence can be acquired, and that vaccines should be tested to reduce the burden of HCV-related liver disease. ----------------- Nyamathi AM. Dixon EL. Robbins W. Smith C. Wiley D. Leake B. Longshore D. Gelberg L. Risk factors for hepatitis C virus infection among homeless adults Journal of General Internal Medicine. 17(2):134-143, 2002 Feb. Abstract OBJECTIVE: To describe the prevalence of hepatitis C virus (HCV) infection in a sample of homeless and impoverished adults and examine risk factors for HCV infection in the overall sample and as a function of injection drug use. DESIGN: Assays were conducted on stored sera. Socio-demographic characteristics and risky sexual activity were measured by content-specific items. Substance use was measured by a structured questionnaire. HCV antibodies were tested by enzyme-linked immunosorbent assay; a confirmatory level was defined by recombinant immunoblot assay. SETTINGS: Shelters (N = 36) and outdoor locations in Los Angeles. PARTICIPANTS: Eight hundred eighty-four homeless women and/or partners or friends. RESULTS: Among this sample of 884 homeless and impoverished adults, 22% were found to be HCV infected. Lifetime injection drug users (IDUs) (cocaine, crack, and methamphetamine) and recent daily users of crack were more likely than nonusers or less-frequent users of these drugs to be HCV-infected. Similar results were found for those who had been hospitalized for a mental health problem. Among non-injection drug users and persons in the total sample, those who reported lifetime alcohol abuse were more likely than those who did not to be HCV infected. Controlling for socio-demographic characteristics, multiple logistic regression analyses revealed IDUs have over 25 times greater odds of having HCV infection than non-IDUs. HCV infection was also predicted by older age, having started living on one's own before the age of 18, and recent chronic alcohol use. Males and recent crack users had about one and a half times greater odds of HCV infection when compared to females and non-chronic crack users. CONCLUSIONS: Targeted outreach for homeless women and their partners, including HCV testing coupled with referrals to HCV and substance abuse treatments, may be helpful. -------------- Charuvastra A. Stein J. Schwartzapfel B. Spaulding A. Horowitz E. Macalino G. Rich JD. Hepatitis B vaccination practices in state and federal prisons Public Health Reports. 116(3):203-209, 2001 May-Jun. Abstract Objective. Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings. Method. The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000. Results. Thirty-five states and the federal system responded (response rate 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates. Conclusions. Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections. ---------- Aitken CK. Kerger M. Crofts N. Peer-delivered hepatitis C testing and counselling: a means of improving the health of injecting drug users Drug & Alcohol Review. 21(1):33-37, 2002 Mar. Abstract We hypothesized that providing injecting drug users (IDUs) with free hepatitis C testing and counselling at a needle and syringe programme (NSP) would be an effective model. Between August 1999 and January 2000, our peer outreach worker offered these services from a busy NSP in western Melbourne. Over 300 counselling episodes were provided, and 47 IDUs who were not tested in the previous 12 months were given tests and full pre- and post-test counselling, and were inter viewed about reasons for not being tested, their knowledge of hepatitis C, and their risk behaviour. Twenty-eight IDUs (59.6%) tested antibody-positive, demonstrating the need to improve testing coverage and compliance with counselling requirements. Most were not tested because they did not think they were at risk, but their reported behaviour and antibody test results showed otherwise. Twenty people returned for a second interview, and improvements in their risk behaviour and knowledge of hepatitis C were detected. Our experience suggests that demand exists for hepatitis C testing and counselling of IDUs in Melbourne's western suburbs, that testing and counselling improve IDUs' ability to avoid harm, and that delivery of these services by a trained and experienced peer located at an NSP is an appropriate and effective model.

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