Ricki Lewis, PhD
Jul 26, 2013
Hepatitis C virus (HCV) infection is on the rise, particularly among young white adults living in rural and suburban areas who abuse intravenous opiate drugs. A review article published in a special supplement to Clinical Infectious Diseases, coinciding with World Hepatitis Week, discusses 6 ways to combat the spread of HCV in this group.
HCV incidence is increasing among those aged 15 to 30 years who inject drugs, according to the US Department of Health and Human Services. HCV is 10 times as infectious as HIV and surpassed HIV in number of deaths in the United States in 2007. Nearly 4 million people in the United States have chronic HCV infection.
For 16 years, Kimberly Page, PhD, MPH, from the University of California, San Francisco, and colleagues have conducted the "U Find Out," or UFO, Study with injection-drug users. The program is modeled on clean syringe programs, but with greater emphasis on social issues that fuel drug abuse and on integrating multiple approaches to combat HCV infection. Data from the ongoing prospective study show that the interventions used can reduce the risk of seroconversion.
In addition, the investigators note that more than 31,000 young adults who inject drugs of abuse will become infected with HCV in the United States each year. "Although there is evidence that HCV incidence has declined in recent decades, if the number of young injectors increases, as the [Centers for Disease Control and Prevention] suggests is occurring in the United States, these gains could be lost. Ongoing and targeted surveillance efforts to enumerate the population at risk and assess the burden of infection are essential steps in targeting and implementing effective HCV prevention in this group," the authors write.
Therefore, they recommend 6 comprehensive measures to prevent the spread of hepatitis C:
Reducing risk from shared ancillary drug preparation equipment, such as containers, rinse water, and filters. The researchers estimate that paying attention to the ancillaries as well as shared syringes could prevent at least 25% of seroconversions. The availability of single-use supplies could lower risk.
Using a new rapid test at point of care that offers results in 20 minutes can detect infection before seroconversion and, combined with counseling, can help to stem transmission.
Addressing social and relational contexts of injecting can encourage uninfected individuals to take precautions when injecting drugs with infected sex partners.
Encouraging "taking a break" from injecting drugs because HCV cannot be transmitted without this behavior. In past studies, the investigators discovered that the more often drug abusers attempted to quit, the more likely they were to eventually succeed.
Developing models to guide delivery of new prevention strategies, including already-available approaches such as increasing syringe availability and future strategies such as direct-acting antivirals that can be used prophylactically, as well as vaccines.
Combining interventions in synergistic ways, such as needle exchange and methadone maintenance programs.
"With ongoing and expanding transmission of HCV, there is little doubt that there is a need to implement what is in the prevention 'toolbox,' as well as add to it," they write. "Expanding HCV prevention and reaching the new generation of young injectors will require dedicated advocacy, pragmatism, and persistence to enable access to all of these technologies."
The work was supported by the National Institute on Drug Abuse. The Kirby Institute is funded by the Australian Government Department of Health and Ageing. One coauthor is also supported by a National Health and Medical Research Council Senior Research Fellowship. The other authors have disclosed no relevant financial relationships.
Clin Infect Dis. 2013;57:S32-S38. Abstract