Bethany White1, Gregory J Dore2, Andrew R Lloyd3, William D Rawlinson4, Lisa Maher2. 1. The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. lmaher@kirby.unsw.edu.au. 2. The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. 3. Inflammation and Infection Research Centre, University of New South Wales, Sydney, NSW, Australia. 4. Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, NSW, Australia.
Abstract
OBJECTIVE: To estimate hepatitis C virus (HCV) incidence and identify associated risk and protective factors among people who inject drugs (PWID) in Sydney, New South Wales. DESIGN, SETTING AND PARTICIPANTS: Community-based prospective observational study of serologically confirmed HCV antibody-negative PWID enrolled in six Sydney neighbourhoods located in three distinct regions between 10 November 2008 and 31 October 2011. MAIN OUTCOME MEASURES: Serologically confirmed HCV incidence per person-years (py); and self-reported demographic and behavioural risk factors for HCV infection. RESULTS: The overall incidence of HCV infection was 7.9/100 py. Risk factors independently associated with incident HCV infection were younger age (adjusted hazard ratio [AHR] for age < 27 years, 5.66; 95% CI, 1.69-18.95; P = 0.005) and daily or more frequent injecting (AHR, 4.06; 95% CI, 1.15-14.30; P = 0.03). Opioid substitution therapy (OST) was protective against HCV seroconversion and was associated with a reduced risk of incident infection among those who mainly injected heroin or other opioids (AHR for those not receiving OST while mainly injecting heroin or other opioids, 5.64; 95% CI, 1.30-24.42; P = 0.02). CONCLUSION: The observed HCV incidence was substantially lower than the incidence of 30.8/100 py observed a decade earlier in a similar NSW-based cohort, suggesting a decline in HCV incidence among PWID. This is likely due to increased coverage of OST, combined with a probable decrease in the population of PWID.
OBJECTIVE: To estimate hepatitis C virus (HCV) incidence and identify associated risk and protective factors among people who inject drugs (PWID) in Sydney, New South Wales. DESIGN, SETTING AND PARTICIPANTS: Community-based prospective observational study of serologically confirmed HCV antibody-negative PWID enrolled in six Sydney neighbourhoods located in three distinct regions between 10 November 2008 and 31 October 2011. MAIN OUTCOME MEASURES: Serologically confirmed HCV incidence per person-years (py); and self-reported demographic and behavioural risk factors for HCV infection. RESULTS: The overall incidence of HCV infection was 7.9/100 py. Risk factors independently associated with incident HCV infection were younger age (adjusted hazard ratio [AHR] for age < 27 years, 5.66; 95% CI, 1.69-18.95; P = 0.005) and daily or more frequent injecting (AHR, 4.06; 95% CI, 1.15-14.30; P = 0.03). Opioid substitution therapy (OST) was protective against HCV seroconversion and was associated with a reduced risk of incident infection among those who mainly injected heroin or other opioids (AHR for those not receiving OST while mainly injecting heroin or other opioids, 5.64; 95% CI, 1.30-24.42; P = 0.02). CONCLUSION: The observed HCV incidence was substantially lower than the incidence of 30.8/100 py observed a decade earlier in a similar NSW-based cohort, suggesting a decline in HCV incidence among PWID. This is likely due to increased coverage of OST, combined with a probable decrease in the population of PWID.
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