Attribution of Hepatitis C Virus Seroconversion Risk in Young Injection Drug Users in 5 US Cities

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http://www.journals.uchicago.edu/doi/abs/10.1086/649783

The Journal of Infectious Diseases 2010;201:378–385

© 2010 by the Infectious Diseases Society of America. All rights reserved.

0022-1899/2010/20103-0010$15.00

DOI: 10.1086/649783

MAJOR ARTICLE

Attribution of Hepatitis C Virus Seroconversion Risk in Young Injection Drug

Users in 5 US Cities

Holly Hagan,1

Enrique R. Pouget,2

Ian T. ,3

L. Garfein,3,4

Steffanie A. Strathdee,4

Sharon M. Hudson,5

H. Latka,7 and

Lawrence J. Ouellet6

1College of Nursing, New York University, and 2National Development and Research

Institutes, New York; 3National Center for Zoonotic, Vectorâ€Borne, and Enteric

Diseases, and National Center for HIV, Hepatitis, STD and TB Prevention, Centers

for Disease Control and Prevention, Atlanta, Georgia; 4University of

California–San Diego School of Medicine, San Diego, and 5Health Research

Association, Los Angeles, California; 6School of Public Health, University of

Illinois at Chicago; 7Aurum Institute for Health Research, Johannesburg, South

Africa

Background.In studies of hepatitis C virus (HCV) seroconversion in injection

drug users (IDUs), some have questioned whether underreporting of syringe

sharing, a stigmatized behavior, has led to misattribution of HCV risk to other

injectionâ€related behaviors.

Methods.IDUs aged 15–30 years who were seronegative for human immunodeficiency

virus and HCV antibodies were recruited into a prospective study in 5 US cities.

Behavioral data were collected via computerâ€assisted selfâ€interviewing to

reduce socially desirable reporting. Hazard ratios (HRs) were estimated to

assess associations between behavior and HCV seroconversion. Because the shared

use of cookers, cottons, and rinse water was highly correlated, a summary

variable was created to represent drug preparation equipment sharing.

Results.Among 483 IDUs who injected during the period covered by the followâ€up

assessments, the incidence of HCV infection was 17.2 cases per 100 person years;

no HIV seroconversions occurred. Adjusting for confounders, the shared use of

drug preparation equipment was significantly associated with HCV seroconversion

(adjusted HR, 2.66; 95% confidence interval, 1.03–23.92), but syringe sharing

was not (adjusted HR, 0.91). We estimated that 37% of HCV seroconversions in

IDUs were due to the sharing of drug preparation equipment.

Conclusions.Associations between sharing drug preparation equipment and HCV

seroconversion are not attributable to underascertainment of syringe sharing.

Avoiding HCV infection will require substantial reductions in exposure to all

sources of contaminated blood.

Received 16 June 2009; accepted 3 September 2009; electronically published 6

January 2010.

Reprints or correspondence: Dr Hagan, New York University College of Nursing,

246 Greene St, Rm 409W New York, NY 10003 (hh50@...).

Potential conflicts of interest: none reported.

Financial support: Division of HIV/AIDS Prevention and Division of Viral

Hepatitis, Centers for Disease Control and Prevention (grants U64/CCU317662,

U64/CCU517656, U64/CCU917655, U64/CCU217659, and U64/CCU017615).

The results and conclusions in this article are those of the authors and do not

necessarily represent the views of the Centers for Disease Control and

Prevention.