Continued Transmission of Hepatitis B and C Viruses, But No Transmission of Human Immunodeficiency Virus Among Intravenous Drug Users Participating in a Syringe/Needle Exchange Program

• Published in: Scandinavian journal of infectious diseases 2000, Vol.32 (3), p.253-258
• Main Authors: MANSSON, A.-S, MOESTRUP, T, NORDENFELT, E, WIDELL, A
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Clinical Medicine; Cohort Studies; Female; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B - transmission; Hepatitis B virus; Hepatitis C - epidemiology; Hepatitis C - prevention & control; Hepatitis C - transmission; Hepatitis C virus; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Human viral diseases; Humans; Incidence; Infectious diseases; Infectious Medicine; Infektionsmedicin; Klinisk medicin; Logistic Models; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Needle-Exchange Programs; Risk Factors; Seroepidemiologic Studies; Substance Abuse, Intravenous; Sweden - epidemiology; Urban Population; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral hepatitis
• ISSN: 0036-5548; 1651-1980; 1651-1980
• DOI: 10.1080/00365540050165875

The virological efficacy of a syringe/needle exchange program was evaluated in a cohort incidence study. Of 698 intravenous drug users (IVDUs) initially recruited, 15 (2.1%) were HIV-positive at baseline. Adequate follow-up was possible in 515 (74%) and showed no new cases of HIV infection during a median of 31 months. Most IVDUs had been previously exposed to HBV (anti-HBc-positive 70.1%) and HCV (anti-HCV-positive 90.7%). Of those 159 IVDUs negative at baseline for anti-HBc and/or anti-HCV, 56 (35%) seroconverted to one or both viruses during follow-up, corresponding to 11.7 seroconversions/100 y at risk for HBV and 26.3 seroconversions/100 y for HCV. Multiple logistic regression analysis showed hepatitis seroconversion to correlate with imprisonment during the study (OR 2.2; 95% CI 1.04-4.74), absence of drug-free periods (OR 5.7; CI 1.44-22.3) and frequent syringe/needle exchanges (OR 1.31; CI 1.02-1.7). The absence of HIV spread was probably partly due to the low prevalence of HIV-infected IVDUs in the city. Despite free syringes and needles, both HBV and HCV continued to spread at high rates. Nevertheless, syringe/needle exchange programs, coupled with monitoring of serostatus provide good surveillance and are valuable for further assessment of remaining risks.