Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Jun;8(6):533-552.
doi: 10.1016/S2468-1253(23)00018-3. Epub 2023 Mar 27.

Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis

Adelina Artenie  1 , Jack Stone  2 , Hannah Fraser  2 , Daniel Stewart  3 , Chiedozie Arum  4 , Aaron G Lim  2 , Anna L McNaughton  2 , Adam Trickey  2 , Zoe Ward  2 , Daniela Abramovitz  5 , Michel Alary  6 , Jacquie Astemborski  7 , Julie Bruneau  8 , Steven J Clipman  9 , Carla S Coffin  10 , Sara Croxford  11 , Kora DeBeck  12 , Eva Emanuel  13 , Kanna Hayashi  14 , Joumana G Hermez  15 , Daniel Low-Beer  16 , Niklas Luhmann  16 , Gisela Macphail  17 , Lisa Maher  18 , Norah E Palmateer  19 , Eshan U Patel  20 , Rachel Sacks-Davis  21 , Wijnand Van Den Boom  22 , Daniela K van Santen  23 , Josephine G Walker  24 , Matthew Hickman  2 , Peter Vickerman  2 ; HIV and HCV Incidence Review Collaborative Group
Collaborators, Affiliations
Meta-Analysis

Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis

Adelina Artenie et al. Lancet Gastroenterol Hepatol. 2023 Jun.

Abstract

Background: Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender.

Methods: In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884.

Findings: Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk.

Interpretation: Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs.

Funding: Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests AA acknowledges support through postdoctoral fellowships from the Canadian Institute of Health Research (CIHR), Fonds de recherche du Québec – Santé (FRQ-S), and the Canadian Network on Hepatitis C. MA reports grants paid to his institution from the Public Health Agency of Canada and grants from the Ministère de la santé et des services sociaux du Québec, during the conduct of this study, and grants from the CIHR, outside the submitted work. JA reports grants from the National Institutes of Health (NIH), during the conduct of this study. JB reports consulting fees from Gilead Sciences, AbbVie, and Cepheid; payment or honoraria from Gilead Sciences for an educational event; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Gilead Sciences, as part of an NIH R01 grant, outside of the submitted work. CSC reports grants from Gilead Sciences, Janssen Pharmaceuticals, and GSK (paid to the University of Calgary); consulting fees from Roche Pharmaceuticals, Gilead Sciences, Janssen Pharmaceuticals (paid to the University of Calgary, on behalf of the Canadian Hepatitis B Virus [HBV] Network), and Altimmune (paid to the University of Calgary, on behalf of the Canadian HBV Network); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events through Gilead Sciences; and patents planned, issued, or pending (PCT/CA2021/050234; international patent application title: polypeptides directed against viral infection and uses thereof; compositions and methodologies for the detection and treatment of HBV infection; USA; 62/982,474; Feb 28, 2020). SC reports payments for chairing or presenting at a European HIV Testing Week webinar from the Centre of Excellence for Health, Immunity and Infections, outside the submitted work. KH reports financial support for the present manuscript paid to her institution from the US National Institute of Drug Abuse (NIDA; Vancouver Drug Users Study: the impacts of evolving drug use patterns on HIV/AIDS; U01DA038886), the Michael Smith Foundation for Health Research Scholar Award, and St Paul's Foundation, and grants or contracts from the CIHR and the William and Ada Isabelle Steel Fund through Simon Fraser University (paid to institution) and the British Columbia Centre on Substance Use (paid to KH). GM reports grants or contracts from AbbVie (clinic support, advisory board, and speaker fees), the Canadian Network on Hepatitis C (research support), Coverdale (clinic support), Gilead Sciences (clinic support and speakers fees), International Network on Health and Hepatitis in Substance Users (INHSU; speaker fees), and TD Bank (clinic support); payment or honoraria from the Canadian Association for the Study of the Liver (scientific planning committee for web-based learning, conjoint with AbbVie; payment to institution), AbbVie (speakers fees for educational podcasts and brochure; payment partly to institution and partly to GM), Gilead Sciences (speaker fees; payment partly to institution and partly to GM), and ECHO plus (honorarium for speaking); and support for attending meetings or travel, or both, from INHSU and being on the advisory board for AbbVie and Gilead. JGW reports grants and contracts from Gilead Sciences and FIND, The Global Alliance for Diagnostics. MH reports having a leadership or fiduciary role as trustee of the Society for the Study of Addiction. All other authors declare no competing interests. Declaration of interests for the members of the HIV and HCV Incidence Review Collaborative Group are provided in the appendix (p 52).

Figures

Figure 1.
Figure 1.
Study selection HCV=hepatitis C virus. RR=relative risk. *Duplicate data refer to different publications that present data from the same study; duplicate records refer to the same publication.
Figure 2.
Figure 2.
Incidence of HIV among people who inject drugs, stratified by WHO region For five records (Kral et al, 2003; Patel et al, unpublished; Niccolai et al, 2011; Teixeira et al, 2004; and Yang et al, 2017), the follow-up duration was imputed from the number of HIV cases and the incidence rate, potentially leading to differences in the estimated 95% CIs relative to those reported in the original study (appendix pp 24–26). Box sizes are proportional to the weight of the study in relation to the pooled incidence. Arrow heads represent estimates that fall completely outside of the axis range. *This study has now been published.
Figure 3.
Figure 3.
Incidence of HCV among people who inject drugs, stratified by WHO region For four records (Balogun et al, 2009; Emanuel and Croxford, unpublished; Hope et al, 2011; and Palmateer and Hutchinson, unpublished), the follow-up duration was imputed from the number of HCV cases and the incidence rate, potentially leading to differences in the estimated 95% CIs relative to those reported in the original study (appendix pp 27–29). Box sizes are proportional to the weight of the study in relation to the pooled incidence. HCV=hepatitis C virus.
Figure 4.
Figure 4.
Association between age (young* vs older PWID) and risk of HIV and HCV acquisition Box sizes are proportional to the weight of the study in relation to the pooled incidence. HCV=hepatitis C virus. NA=not available. PWID=people who inject drugs. *Threshold varied between studies: median value was 25 years (IQR 25–28; range 24–34) for HIV and 25 years (24–25; 20–31) for HCV. †This study has now been published.
Figure 4.
Figure 4.
Association between age (young* vs older PWID) and risk of HIV and HCV acquisition Box sizes are proportional to the weight of the study in relation to the pooled incidence. HCV=hepatitis C virus. NA=not available. PWID=people who inject drugs. *Threshold varied between studies: median value was 25 years (IQR 25–28; range 24–34) for HIV and 25 years (24–25; 20–31) for HCV. †This study has now been published.
Figure 5.
Figure 5.
Association between sex or gender and risk of HIV and HCV acquisition in PWID Box sizes are proportional to the weight of the study in relation to the pooled incidence. HCV=hepatitis C virus. NA=not available. PWID=people who inject drugs. *This study has now been published.
Figure 5.
Figure 5.
Association between sex or gender and risk of HIV and HCV acquisition in PWID Box sizes are proportional to the weight of the study in relation to the pooled incidence. HCV=hepatitis C virus. NA=not available. PWID=people who inject drugs. *This study has now been published.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health 2017; 5: e1192–207. - PMC - PubMed
    1. UNAIDS. 90–90–90 An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS, 2014. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf(accessed May 5, 2020).
    1. WHO. Global health sector strategy on viral hepatitis 2016–2021. Geneva, Switzerland: World Health Organization, 2016. http://apps.who.int/iris/bitstream/10665/246177/1/WHO-HIV-2016.06-eng.pd... (accessed Aug 5, 2017).
    1. Artenie A, Luhmann N, Lim AG, et al. Methods and indicators to validate country reductions in incidence of hepatitis C virus infection to elimination levels set by WHO. Lancet Gastroenterol Hepatol 2022; 7: 353–66. - PMC - PubMed
    1. Mitchell KM, Maheu-Giroux M, Dimitrov D, et al. How can progress toward ending the human immunodeficiency virus epidemic in the United States be monitored? Clin Infect Dis 2022; 75: 163–69. - PMC - PubMed

Publication types