April 22, 2019
2 min read

Most injection drug users in 8 US cities have been infected with HCV

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More than 55% of people who inject drugs, or PWID, in eight United States cities were found to have been infected with hepatitis C virus, including almost half of young PWID, according to study findings that also showed infection was associated with risky injection practices.

“Recent HCV infection outbreaks among networks of PWID have demonstrated a changing demographic of HCV-infected PWID. Outbreaks of acute HCV infection have been reported among young PWID (18-35 years), the majority of whom are non-Hispanic white and frequently report a history of prescription opioid misuse,” Winston E. Abara, MD, PhD, from the CDC’s Division of Viral Hepatitis, and colleagues wrote.

The opioid crisis has fueled the recent increases in acute HCV infection, particularly among young PWID. Most young PWID begin by misusing prescription opioids and subsequently transition to injecting heroin because it is cheaper, more potent and more widely available than prescription opioids. Because young PWID are more likely to have just started injecting compared to older PWID, the increase in injection heroin and other opioid use among young people has been associated with increases in acute HCV infections.”

Abara and colleagues assessed the age-related prevalence of and factors associated with past or present HCV infection among PWID recruited in Chicago, Dallas, Denver, Los Angeles, New Orleans, New York, Seattle and Nassau-Suffolk counties in New York.

According to the study, among 4,094 PWID, 55.2% were HCV antibody-positive (anti-HCV). Among young PWID, anti-HCV prevalence was 42.1%, and associated with a high school education or lower (adjusted PR = 1.17; 95%, CI = 1.03-1.32), receptive syringe sharing (aPR = 1.37; 95%, CI = 1.21-1.56) injection equipment sharing (aPR = 1.16; 95% CI = 1.01-1.35), arrest history (aPR = 1.14; 95% CI, 1.02-1.29) and injecting a heroin and cocaine mixture, or speedball (aPR = 1.37; 95%, CI = 1.16-1.61).

The study found that HCV prevalence was 62.2% among older PWID and was similarly associated with education of high school level or lower (aPR = 1.08; 95%, CI = 1.02-1.15), injection equipment sharing (aPR = 1.08; 95%, CI = 1.02-1.15) and injecting speedball (aPR = 1.09; 95%, CI = 1.01-1.16), as well as high injection frequency (aPR = 1.16; 95%, CI = 1.01-1.34).

“Given the current opioid crisis, it is likely that HCV infection attributable to injection drug use will continue to increase, particularly among young PWID. Education about hepatitis C risk behaviors and expanding hepatitis C testing is essential to identify HCV-infected PWID,” the authors concluded.


“Combination hepatitis C prevention interventions like SSP, MAT, and DAA treatment for infected PWID are effective in reducing HCV transmission risk and disease burden among PWID. Access to effective DAA treatment in particular must be improved, otherwise it can limit the effectiveness of other prevention approaches like MAT and SSP. Scaling up these HCV prevention interventions and addressing the system-level barriers that affect access to them is critical to their effectiveness.” – by Caitlyn Stulpin

Disclosures: The author report no relevant financial disclosures.