Connect
MJA
MJA

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

Summary

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.

Please login with your free MJA account to view this article in full

  • 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.

Correspondence: lmaher@kirby.unsw.edu.au

Acknowledgements: 

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.

  • 1. Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 2011; 378: 571-583.
  • 2. Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008; 372: 1733-1745.
  • 3. Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010; 375: 1014-1028.
  • 4. Topp L, Day CA, Iversen J, et al; Collaboration of Australian NSPs. Fifteen years of HIV surveillance among people who inject drugs: the Australian Needle and Syringe Program Survey 1995–2009. AIDS 2011; 25: 835-842.
  • 5. Iversen J, Wand H, Topp L, et al. Extremely low and sustained HIV incidence among people who inject drugs in a setting of harm reduction. AIDS 2014; 28: 275-278. doi: 10.1097/QAD.0000000000000068.
  • 6. Iversen J, Topp L, Maher L. Australian NSP Survey national data report 1995–2010. Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney: The Kirby Institute, University of New South Wales, 2011.
  • 7. Maher L, Jalaludin B, Chant K, et al. Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Addiction 2006; 101: 1499-1508.
  • 8. Razali K, Thein HH, Bell J, et al. Modelling the hepatitis C virus epidemic in Australia. Drug Alcohol Depend 2007; 91: 228-235.
  • 9. Australian Government Department of Health and Ageing. Fourth National Hepatitis C Strategy 2014–2017. Canberra: Commonwealth of Australia; 2014. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-hepc (accessed Aug 2014).
  • 10. White B, Dore GJ, Lloyd A, et al. Ongoing susceptibility to hepatitis B virus infection among people who inject drugs in Sydney. Aust N Z J Public Health 2012; 36: 351-357.
  • 11. Maher L, White B, Donald A, et al. Using ethnographic fieldwork to inform hepatitis C vaccine preparedness studies with people who inject drugs. Int J Drug Policy 2010; 21: 194-201.
  • 12. Semaan S, Lauby J, Liebman J. Street and network sampling in evaluation studies of HIV risk-reduction interventions. AIDS Rev 2002; 4: 213-223.
  • 13. Maher L, Li J, Jalaludin B, et al. High hepatitis C incidence in new injecting drug users: a policy failure? Aust N Z J Public Health 2007; 31: 30-35.
  • 14. van Beek I, Dwyer R, Dore G, et al. Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study. BMJ 1998; 317: 433-437.
  • 15. Iversen J, Wand H, Topp L, et al. Reduction in HCV incidence among injection drug users attending needle and syringe programs in Australia: a linkage study. Am J Public Health 2013; 103: 1436-1444.
  • 16. MacArthur GJ, Minozzi S, Martin N, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ 2012; 345: e5945.
  • 17. Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis 2011; 204: 74-83.
  • 18. Craine N, Hickman M, Parry JV, et al. Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size. Epidemiol Infect 2009; 137: 1255-1265.
  • 19. Turner KM, Hutchinson S, Vickerman P, et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction 2011; 106: 1978-1988.
  • 20. Australian Institute of Health and Welfare. National opioid pharmacotherapy statistics annual data collection: 2011 report. Canberra: AIHW, 2012. (AIHW Cat. No. HSE 121.)
  • 21. van den Berg C, Smit C, Bakker M, et al. Major decline of hepatitis C virus incidence rate over two decades in a cohort of drug users. Eur J Epidemiol 2007; 22: 183-193.
  • 22. Mehta SH, Astemborski J, Kirk GD, et al. Changes in blood-borne infection risk among injection drug users. J Infect Dis 2011; 203: 587-594.
  • 23. Martin NK, Vickerman P, Grebely J, et al. Hepatitis C virus treatment for prevention among people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals. Hepatology 2013; 58: 1598-1609.
  • 24. Walsh N, Maher L. HIV and viral hepatitis C coinfection in people who inject drugs: implications of new direct acting antivirals for hepatitis C virus treatment. Curr Opin HIV AIDS 2012; 7: 339-344.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.