Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study

BMJ 1998;317:433-437 ( 15 August )

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Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study

Editorial by Coutinho

Ingrid van Beek, director, ^a Robyn Dwyer, research coordinator, ^a Gregory J Dore, lecturer in epidemiology, ^b Kehui Luo, statistician, ^b John M Kaldor, deputy director, professor of epidemiology. ^b

^a Kirketon Road Centre, PO Box 22, Kings Cross, New South Wales 1340, Australia, ^b National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia

Correspondence to: Dr van Beek ivanbeek{at}ozemail.com.au

Objectives: To estimate the incidence of HIV and hepatitis C virus and risk factors for seroconversion among a cohortof injecting drugusers.
Design: Retrospective cohortstudy.
Setting: Primary healthcare facility in central Sydney.
Subjects: Injecting drug users tested for HIV-1 antibody (n=1179) and antibodies to hepatitis C virus (n=1078) fromFebruary 1992 to October 1995.
Main outcome measures: Incidence of HIV-1 and hepatitis C virus among seronegative subjects who injected drugs andunderwent repeat testing. Demographic and behavioural risk factorsfor hepatitisseroconversion.
Results: Incidence of HIV-1 among 426 initially seronegative injecting drug users was 0.17/100 person years (two seroconversions)compared with an incidence of hepatitis C virus of 20.9/100 personyears (31 seroconversions) among 152 injecting drug users initiallynegative for hepatitis C virus. Incidence of hepatitis C virusamong injecting drug users aged less than 20 years was 75.6/100person years. Independent risk factors for hepatitis C virus seroconversionwere age less than 20 years and a history of imprisonment.
Conclusions: In a setting where prevention measures have contributed to the maintenance of low prevalence and incidenceof HIV-1, transmission of hepatitis C virus continues at extremelyhigh levels, particularly among young injecting drugusers.

Key messages

The prevalence and incidence of hepatitis C virus is high, while the prevalence and incidence of HIV remains low among injecting drug users
Young age and history of imprisonment are risk factors for acquisition of hepatitis C virus infection
HIV prevention strategies have been relatively ineffective in preventing hepatitis C virus infection in this population
The role of imprisonment in the acquisition of hepatitis C infection should be further investigated

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