Intended for healthcare professionals


Minimising harm from hepatitis C virus needs better strategies

BMJ 2000; 321 doi: (Published 07 October 2000) Cite this as: BMJ 2000;321:899
  1. Nick Crofts (crofts{at}, head,
  2. Sonia Caruana, research assistant,
  3. Scott Bowden, molecular microbiologist,
  4. Michael Kerger, outreach worker
  1. Epidemiology and Social Research Unit, Macfarlane Burnet Centre for Medical Research, PO Box 254, Fairfield, Victoria 3078, Australia
  2. Victorian Infectious Diseases Reference Laboratory, Locked Bag 815, Carlton South, Victoria 3053, Australia
  3. Centre for Harm Reduction/Macfarlane Burnet Centre for Medical Research, Footscray, Victoria 3011, Australia

    EDITOR—Hepatitis C virus and HIV are both blood borne, and infection may occur in injecting drug users, transmitted by sharing contaminated needles and syringes. Despite extensive harm reduction programmes in Australia, hepatitis C virus continues to spread among injecting drug users, but HIV does not, partly because the prevalence of hepatitis C virus has been high among injecting drug users in Australia since at least 1971, whereas that of HIV, present only from around 1982, has remained low.1

    Hepatitis C virus has a higher average transmission efficiency than HIV.2 It may be transmitted between injecting drug users on equipment other than needles and syringes.3 Injecting drug users in Australia commonly share other equipment—for example swabs, spoons filters, water, and tourniquets.

    We studied used injecting equipment from 10 injecting settings for the presence of hepatitis C virus RNA, with one to four injecting drug users at each setting, at least one of whom was known to be positive for hepatitis C as shown by the results of a polymerase chain reaction. All used injecting equipment was collected and transported immediately to the laboratory. Hepatitis C virus RNA was isolated and purified from equipment using reagents in the QIAGEN QIAamp Viral RNA kit (QIAGEN, Australia).

    Needles and syringes were flushed with the QIAGEN lysis buffer, spoons and swabs were rinsed or vortexed in lysis buffer, and water was processed as for serum in the manufacturer's protocol. All samples were tested for hepatitis C virus RNA with the AMPLICOR hepatitis C virus test (Roche Diagnostic Systems, Branchburg, NJ).

    Hepatitis C virus RNA was detected on 70% (14/20) of syringes, 67% (6/9) of swabs, 40% (2/5) of filters, 25% (1/4) of spoons, and 33% (1/3) of water samples.

    These findings imply that hepatitis C virus could be transmitted among injecting drug users on injecting equipment other than needles and syringes; evidence from behavioural studies suggests that such transmission may not be uncommon. 3 4 The public health message used in these groups for control of HIV transmission—not to share needles and syringes—may therefore be inadequate for control of hepatitis C virus, and other strategies must be canvassed, such as encouraging injecting drug users to use their drugs in ways other than injecting; more intense concentration on hygiene practices including handwashing; and education and support of injecting drug users to avoid sharing any equipment associated with injecting. A serious commitment to new and expanded harm minimisation strategies will be needed to reduce the continual spread of hepatitis C virus among injecting drug users, along with the growing toll of illness and cost.5


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