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Multicenter Study
. 2017 Apr 1;64(7):860-869.
doi: 10.1093/cid/ciw869.

Geographic Differences in Temporal Incidence Trends of Hepatitis C Virus Infection Among People Who Inject Drugs: The InC3 Collaboration

Meghan D Morris  1 , Stephen Shiboski  1 , Julie Bruneau  2 , Judith A Hahn  3 , Margaret Hellard  4 , Maria Prins  5 , Andrea L Cox  6 , Gregory Dore  7 , Jason Grebely  7 , Arthur Y Kim  8 , Georg M Lauer  8 , Andrew Lloyd  7   9 , Thomas Rice  1 , Naglaa Shoukry  2 , Lisa Maher  7 , Kimberly Page  10 ; International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3)
Affiliations
Multicenter Study

Geographic Differences in Temporal Incidence Trends of Hepatitis C Virus Infection Among People Who Inject Drugs: The InC3 Collaboration

Meghan D Morris et al. Clin Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2017 Aug 15;65(4):706-707. doi: 10.1093/cid/cix450. Clin Infect Dis. 2017. PMID: 29017273 Free PMC article. No abstract available.

Abstract

Background: We determined temporal trends (1985-2011) in hepatitis C virus (HCV) incidence and associated behavioral exposures for people who inject drugs (PWID) from the United States (Boston, Baltimore, and San Francisco), Canada (Montreal), the Netherlands (Amsterdam), and Australia (Sydney and Melbourne).

Methods: Using population-based cohort data from HCV-negative PWID, we calculated overall and within-city HCV incidence trends, HCV rates by study enrollment period (1985-2011), and temporal trends in exposure behaviors. Poisson regression models estimated trends in HCV incidence over calendar-time. Survival models identified risk factors for HCV incidence across cities and estimated independent effects of city and calendar period on HCV infection risk.

Results: Among 1391 initially HCV-negative participants followed prospectively (1644.5 person-years of observation [PYO]), 371 HCV incident infections resulted in an overall incidence of 22.6 per 100 PYO (95% confidence interval [CI], 20.4-25.0). Incidence was highest and remained elevated in Baltimore (32.6/100 PYO), San Francisco (24.7/100 PYO), and Montreal (23.5/100 PYO), lowest in Melbourne and Amsterdam (7.5/100 PYO and 13.1/100 PYO, respectively), and moderate (21.4/100 PYO) in Sydney. Higher rates of syringe and equipment sharing and lower prevalence of opioid agonist therapy were associated with HCV incidence in cities with the highest incidence. Risk for infection dropped by 18% for every 3-year increase in calendar-time (adjusted hazard ratio, 0.8 [95% CI, .8-.9]) in the multivariable model.

Conclusions: Differences in prevention strategies and injecting contexts may explain the ongoing high HCV incidence in these North American cities and emphasize the need for scale-up of opioid agonist therapy and increased coverage of needle and syringe programs in North America.

Keywords: epidemiology; harm reduction strategies.; hepatitis C virus (HCV); incidence trends; people who inject drugs.

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Figures

Figure 1.
Figure 1.
Participant inclusion flowchart. Abbreviations: HCV, hepatitis C virus; InC3, International Collaboration of Incident HIV and HCV in Injecting Cohorts.
Figure 2.
Figure 2.
Trends in hepatitis C virus (HCV) incidence density (per 100 person-years) across calendar period, by city. Vertical lines represent 95% confidence intervals. Abbreviation: HCV, hepatitis C virus.
Figure 3.
Figure 3.
Trends in proportions of self-reported exposures across calendar period, by city. Measurement of selected exposure behaviors collected at enrollment. Proportions were calculated for 1985–1990 and 3-year intervals from 1991 to 2011. Note that the Baltimore (Maryland) cohort does not collect survey data. Abbreviations: OAT, opioid agonist therapy; RSS, receptive syringe sharing.
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