Hepatitis C virus infection among injecting drug users in Scotland: a review of prevalence and incidence data and the methods used to generate them

Abstract

It is estimated that of 50,000 persons in Scotland (1% of the county's population), infected with the hepatitis C virus (HCV), around 90% injected drugs. This paper reviews data on the prevalence and incidence of HCV, and the methods used to generate such information, among injecting drug users (IDUs), in Scotland. The prevalence estimate for HCV among IDUs in Scotland as a whole (44% in 2000), is comparable with those observed in many European countries. Incidence rates ranged from 11.9 to 28.4/100 person-years. The data have shaped policy to prevent infection among IDUs and have informed predictions of the number of HCV-infected IDUs who will likely progress to, and require treatment and care for, severe HCV-related liver disease. Although harm reduction interventions, in particular needle and syringe exchanges and methadone maintenance therapy, reduced the transmission of HCV among IDUs during the early to mid-1990s, incidence in many parts of the country remains high. The prevention of HCV among IDUs continues to be one of Scotland's major public health challenges.

Fig. 1

Cumulative cases of diagnosed HCV infection among IDUs (by NHS Board of source of specimen, cumulative 1991 to end June 2005 per 100 000 population).

Fig. 2

HCV prevalence among IDUs, in four urban centres in Scotland, who had an attributable HIV test between 1989 and 2000. GG, Greater Glasgow NHS Board; TY, Tayside NHS Board; GR, Grampian NHS Board; LO, Lothian NHS Board.