From Medscape Medical News
Megan Brooks
March 27, 2012 (New York, New York) — Scaling up prevention and treatment programs will help control and possibly eliminate the transmission of HIV and hepatitis C virus (HCV) among people who inject drugs, according to a poster abstract presented here at the International Conference on Viral Hepatitis 2012.
"With prevention efforts like syringe exchange, drug dependence treatment, and treatment for hepatitis C and HIV, we really have the potential to either eliminate transmission of those viruses among people who inject drugs or get it down to close to trivial levels," study author Don C. Des Jarlais, PhD, noted in an interview with Medscape Medical News. Dr. Des Jarlais is director of research at the Rothschild Chemical Dependency Institute, Beth Israel Medical Center, in New York City.
"People who inject drugs are at very high risk of infection with HIV and hepatitis C," Dr. Des Jarlais explained. "Is it going to be possible to eliminate HIV and HCV in people who inject drugs? We did a literature review and meta-analysis looking specifically at combined prevention and treatment and concluded that yes, it is certainly conceivable to eliminate transmission of those viruses among people who inject drugs," he said.
Moving in the Right Direction
Current estimates put the number of injection drug users at 16 million. Of these, 10 million are HCV-seropositive and 3 million are HIV-seropositive. Most live in low/middle-income countries; however, there has been a recent increase in new injectors in the United States, the researchers report. The estimated incidence of HCV infection ranges from 10 to 40 per 100 person-years; for HIV, it ranges from approximately 0.5 to 10.0 per 100 person-years.
On the basis of their analysis, Dr. Des Jarlais and colleagues estimate that combined prevention programs — particularly needle-exchange programs, drug dependence treatment, counseling, and testing — should be able to reduce HIV incidence to less than 0.5 per 100 person-years.
If this were the case, it would be "providing effective control," he said. The same programs applied to HCV could reduce incidence to 2.5 to 5.0 per 100 person-years, they report.
They also say that treatment for HCV infection, including new direct-acting antivirals, "might substantially reduce HCV transmission below these levels, but would be required on a large-scale basis, with 70% or more of currently infected persons treated."
"It's going to take prevention efforts like syringe exchange, pharmacy sales of syringes, and providing treatment for drug dependence," Dr. Des Jarlais said. "We are moving in that direction; certainly the new direct-acting antivirals are a huge advance. Without them, one wouldn't really consider the likelihood of treating large numbers of people who are infected with hepatitis C because the old treatments were really not that good," he told Medscape Medical News.
He also noted that although "many more people are getting screened, there are still a lot of gaps in getting someone screened, evaluated, and successfully treated. There is a big fall off at each of those steps."
Dr. Des Jarlais has disclosed no relevant financial relationships.
International Conference on Viral Hepatitis (ICVH) 2012: Poster abstract 79359. Presented March 26, 2012.
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