Opioid substitution therapy protects against hepatitis C virus acquisition in people who inject drugs: the HITS-c study

Bethany White, Gregory J Dore, Andrew R Lloyd, William D Rawlinson and Lisa Maher
Med J Aust 2014; 201 (6): 326-329. || doi: 10.5694/mja13.00153


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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  • Bethany White1,2
  • Gregory J Dore1
  • Andrew R Lloyd3
  • William D Rawlinson4
  • Lisa Maher1

  • 1 The Kirby Institute, University of New South Wales, Sydney, NSW.
  • 2 Discipline of Addiction Medicine, Sydney Medical School, University of Sydney, Sydney, NSW.
  • 3 Inflammation and Infection Research Centre, University of New South Wales, Sydney, NSW.
  • 4 Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, NSW.



We thank the study participants and their communities for their time and commitment to the study. For recruiting and interviewing participants, we are grateful to Anna Bates, Jarliene Enriquez, Sammy Chow, Ju Park, Len Liao and Aylza Donald. For logistic support for specimen handling, we thank Suzy Teutsch, Hui Li, Brendan Jacka and Alicia Steller. Thanks also to Handan Wand for statistical advice and Carolyn Day for comments on earlier drafts of the manuscript. This study was initially funded by the University of New South Wales (UNSW Hepatitis C Vaccine Initiative) and subsequently by a National Health and Medical Research Council (NHMRC) grant (630483, Hepatitis C Vaccine Preparedness Study). Bethany White was supported by an NHMRC Dora Lush Biomedical Research Postgraduate Scholarship, and Lisa Maher is supported by an NHMRC Senior Research Fellowship. Gregory Dore and Andrew Lloyd are supported by NHMRC Practitioner Fellowships. The Kirby Institute is affiliated with the Faculty of Medicine, UNSW.

Competing interests:

No relevant disclosures.

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