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PLoS One. 2014 Jun 4;9(6):e97726. doi: 10.1371/journal.pone.0097726. eCollection 2014.

Declining incidence of hepatitis C virus infection among people who inject drugs in a Canadian setting, 1996-2012.

Author information

  • 1The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
  • 2British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • 3Department of Epidemiology, Brown University, Providence, Rhode Island, United States of America.
  • 4British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • 5British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada.
  • 6British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.

Abstract

BACKGROUND:

People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection. Trends in HCV incidence and associated risk factors among PWID recruited between 1996 and 2012 in Vancouver, Canada were evaluated.

METHODS:

Data were derived from a long-term cohort of PWID in Vancouver. Trends in HCV incidence were evaluated. Factors associated with time to HCV infection were assessed using Cox proportional hazards regression.

RESULTS:

Among 2,589, 82% (n = 2,121) were HCV antibody-positive at enrollment. Among 364 HCV antibody-negative participants with recent (last 30 days) injecting at enrollment, 126 HCV seroconversions were observed [Overall HCV incidence density: 8.6 cases/100 person-years (py); 95% confidence interval (95% CI): 7.2, 10.1; HCV incidence density among those with injecting during follow-up: 11.5 cases/100 py; 95% CI 9.7, 13.6]. The overall HCV incidence density declined significantly from 25.0/100 py (95% CI: 20.2, 30.3) in 1996-99, as compared to 6.0/100 py (95% CI: 4.1, 8.5) in 2000-2005, and 3.1/100 py (95% CI: 2.0, 4.8) in 2006-2012. Among those with injecting during follow-up, the overall HCV incidence density declined significantly from 27.9/100 py (95% CI: 22.6, 33.6) in 1996-99, as compared to 7.5/100 py (95% CI: 5.1, 10.6) in 2000-2005, and 4.9/100 py (95% CI: 3.1, 7.4) in 2006-2012. Unstable housing, HIV infection, and injecting of cocaine, heroin and methamphetamine were independently associated with HCV seroconversion.

CONCLUSIONS:

HCV incidence has dramatically declined among PWID in this setting. However, improved public health strategies to prevent and treat HCV are urgently required to reduce HCV-associated morbidity and mortality.

PMID:
24897109
[PubMed - in process]
PMCID:
PMC4045728
Free PMC Article
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