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van Santen DK, Boyd A, Matser A, Maher L, Hickman M, Lodi S, Prins M. The effect of needle and syringe program and opioid agonist therapy on the risk of HIV, hepatitis B and C virus infection for people who inject drugs in Amsterdam, the Netherlands: findings from an emulated target trial. Addiction 2021; 116:3115-3126. [PMID: 33788326 DOI: 10.1111/add.15503] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/30/2020] [Accepted: 03/17/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm-reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands. DESIGN We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985-2014). SETTING Amsterdam, the Netherlands. PARTICIPANTS We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively. INTERVENTIONS Intervention arms were: complete HRP participation [≥ 60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use] versus no HRP and partial HRP participation combined (< 60 methadone mg/day and/or < 100% NSP coverage). CONCLUSIONS Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands. MEASUREMENTS Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models. FINDINGS Compared with no/partial HRP participation, complete HRP participation led to lower risk of HIV [HR = 0.54, 95% confidence interval (CI) = 0.27-1.08], HCV (HR = 0.16, 95% CI = 0.06-0.40) and HBV (HR = 0.28, 95% CI = 0.13-0.61) acquisition.
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Affiliation(s)
- Daniela K van Santen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AIandII), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Cox A, Sulkowski M, Sugarman J. Ethical and Practical Issues Associated With the Possibility of Using Controlled Human Infection Trials in Developing a Hepatitis C Virus Vaccine. Clin Infect Dis 2020; 71:2986-2990. [PMID: 32442262 PMCID: PMC7778335 DOI: 10.1093/cid/ciaa640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/21/2020] [Indexed: 01/15/2023] Open
Abstract
Despite the existence of established treatments for hepatitis C virus (HCV), more effective means of preventing infection, such as a vaccine, are arguably needed to help reduce substantial global morbidity and mortality. Given the expected challenges of developing such a vaccine among those at heightened risk of infection, controlled human infection studies seem to be a promising potential approach to HCV vaccine development, but they raise substantial ethical and practical concerns. In this article, we describe some of the challenges related to the possibility of using controlled human infection studies to accelerate HCV vaccine development. The related ethical and practical concerns require further deliberation before such studies are planned and implemented.
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Affiliation(s)
- Andrea Cox
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark Sulkowski
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeremy Sugarman
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
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3
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MacLachlan JH, Cowie BC. Uptake and trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia, 2013-2014. Sex Health 2019; 14:188-192. [PMID: 27764649 DOI: 10.1071/sh16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 09/08/2016] [Indexed: 11/23/2022]
Abstract
Background The Department of Health and Human Services in Victoria provides funded hepatitis B vaccine to many priority groups at risk of acquiring infection. We aimed to determine the uptake of vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk. METHODS Routinely collected administrative data regarding the indication for vaccine ordered by practitioners were analysed for the period June 2013 to December 2014. Number of doses and courses distributed was determined and compared with the estimated size of the priority populations. RESULTS During the 18-month period assessed, 20498 doses of funded hepatitis B vaccine were ordered, equating to ~5700 complete courses, with the overall number of orders per quarter increasing between 2013 and 2014. The most common indication was being a household or sexual contact of people living with hepatitis B (2803 courses, 49.2% of the total), equating to approximately one course per new chronic hepatitis B notification. The remaining doses were largely distributed to people living with HIV (648 courses, 11.4%), people living with hepatitis C (621 courses, 10.9%), and people who inject drugs (594 courses, 10.4%). CONCLUSIONS This analysis demonstrates that access to hepatitis B immunisation among priority populations appears to have increased in Victoria during 2013-14, however it could still be improved. Continued assessment of these data over time will be important to measure the impact of interventions on increasing the reach of the funded vaccine program.
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Affiliation(s)
- Jennifer H MacLachlan
- World Health Organization Collaborating Centre for Viral Hepatitis, The Doherty Institute, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia
| | - Benjamin C Cowie
- World Health Organization Collaborating Centre for Viral Hepatitis, The Doherty Institute, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia
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4
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Wang H, Swann R, Thomas E, Innes HA, Valerio H, Hayes PC, Allen S, Barclay ST, Wilks D, Fox R, Bhattacharyya D, Kennedy N, Morris J, Fraser A, Stanley AJ, Gunson R, Mclntyre PG, Hunt A, Hutchinson SJ, Mills PR, Dillon JF. Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis. J Viral Hepat 2018; 25:930-938. [PMID: 29577515 DOI: 10.1111/jvh.12897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/11/2018] [Indexed: 12/13/2022]
Abstract
Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.
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Affiliation(s)
- H Wang
- Dundee Epidemiology and Biostatistics Unit, Population Health Sciences, University of Dundee, Dundee, UK
| | - R Swann
- Department of Gastroenterology, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - E Thomas
- Department of Medicine for the Elderly, North Middlesex Hospital, London, UK
| | - H A Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - H Valerio
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - P C Hayes
- Liver Transplant Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - S Allen
- Department of Infectious Diseases, University Hospital Crosshouse, Kilmarnock, UK
| | - S T Barclay
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - D Wilks
- Department of Infectious Diseases, Western General Hospital, Edinburgh, UK
| | - R Fox
- The Brownlee Centre, Glasgow, UK
| | | | | | - J Morris
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - A Fraser
- Aberdeen Royal Infirmary, Aberdeen, UK
| | - A J Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - R Gunson
- West of Scotland Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - P G Mclntyre
- Department of Microbiology, Ninewells Hospital and Medical School, Dundee, UK
| | - A Hunt
- Department of Virology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - P R Mills
- Department of Gastroenterology, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J F Dillon
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
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Cadavid-Betancur DA, Ospina MC, Hincapié-Palacio D, Bernal-Restrepo LM, Buitrago-Giraldo S, Perez-Toro O, Santacruz-Sanmartín E, Lenis-Ballesteros V, Almanza-Payares R, Díaz FJ. Seroprevalence of hepatitis B and factors potentially associated in a population-based study in Medellin, Colombia. Vaccine 2017; 35:4905-4912. [PMID: 28780978 DOI: 10.1016/j.vaccine.2017.07.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/27/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
The seroprevalence of hepatitis B (HB) and of potentially associated factors in Medellin, Colombia, were investigated 17years after the start of universal vaccination. Biological and sociodemographic data from a population survey with a multistage random sampling were analyzed in 6-64year old individuals. HB surface antigen, total HB core antibodies and HB surface antibodies, and in some cases IgM antibodies to HB core antigen, were tested in 2077 samples. Factors potentially associated with and natural, and vaccine immunity relative to susceptibility (absence of any marker) were analyzed using a multinomial logistic regression. The prevalence of serological patterns was: chronic infection 0.20% (95% CI 0.11-0.71), vaccine immunity 25.10% (95% CI 21.72-28.83) and natural immunity 2.60% (95% CI 1.80-3.74). No markers were detected in 71.30% (95% CI 67.70-74.83) of the individuals and evidence of recent infection was not detected. Relative to the absence of markers, natural immunity was potentially associated with age (6-17years and 41-64years) and sleeping less than 6 hours, while vaccine immunity was associated with age (6-17years), reporting vaccination against HB, belonging to high socioeconomic strata, home ownership and being obese, after adjusting for other variables. These results may be a population effect of mass vaccination. It is recommended to complete the vaccination schedule and to study in detail, persistence of antibodies and the role of obesity and socioeconomic strata in the vaccine immunity.
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Affiliation(s)
- David A Cadavid-Betancur
- Group of Epidemiology, National School of Public Health, 'Héctor Abad Gómez' - University of Antioquia, Calle 62 # 52-29 Of. 226, Medellín, Colombia; GIVET Research Group, Facultad de Ciencias Administrativas y Agropecuarias, Corporación Universitaria Lasallista, Caldas, Colombia.
| | - Marta C Ospina
- Laboratory of Public Health of the Regional Secretariat of Health and Social Protection of Antioquia, Carrera 72a # 78b-141, tercer piso, Medellín, Colombia.
| | - Doracelly Hincapié-Palacio
- Group of Epidemiology, National School of Public Health, 'Héctor Abad Gómez' - University of Antioquia, Calle 62 # 52-29 Of. 226, Medellín, Colombia.
| | - Luz M Bernal-Restrepo
- Laboratory of Public Health of the Regional Secretariat of Health and Social Protection of Antioquia, Carrera 72a # 78b-141, tercer piso, Medellín, Colombia.
| | - Seti Buitrago-Giraldo
- Laboratory of Public Health of the Regional Secretariat of Health and Social Protection of Antioquia, Carrera 72a # 78b-141, tercer piso, Medellín, Colombia.
| | - Olga Perez-Toro
- Laboratory of Public Health of the Regional Secretariat of Health and Social Protection of Antioquia, Carrera 72a # 78b-141, tercer piso, Medellín, Colombia.
| | | | - Viviana Lenis-Ballesteros
- National School of Public Health, 'Héctor Abad Gómez' - University of Antioquia, Calle 62 # 52-29 Of. 226, Medellín, Colombia.
| | - Rita Almanza-Payares
- Secretariat of Health, Calle 44 N 52 - 165 Centro Administrativo La Alpujarra, Medellín, Colombia.
| | - Francisco J Díaz
- Group of Inmunovirology, School of Medicine - University of Antioquia, Calle 62 #52-59, Medellín, Colombia.
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Rowe R, Berger I, Yaseen B, Copeland J. Risk and blood-borne virus testing among men who inject image and performance enhancing drugs, Sydney, Australia. Drug Alcohol Rev 2017; 36:658-666. [PMID: 28244160 DOI: 10.1111/dar.12467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Needle and syringe program (NSP) workers have highlighted that people who inject image and performance enhancing drugs (IPED) in Australia are a younger and more culturally and linguistically diverse (CALD) group compared with other groups who inject drugs. Previous research has found riskier injecting practices and faster Hepatitis C acquisition rates among people who are new to injecting drugs and self-identify with CALD backgrounds, compared with their Anglo-Australian counterparts. Given recent indications of increasing IPED prevalence in Australia and elsewhere, this study sought to update knowledge of infection risk among a large group of IPED injectors, as well as explore sub-group differences. DESIGN AND METHODS A cross-sectional survey of men who inject IPEDs was conducted from September 2014 to January 2015 at nine NSP sites, across five local health districts in Sydney, Australia. RESULTS Six hundred and five people participated. Small proportions reported previous 12month needle or syringe sharing (2.3%), sharing vials (4.6%), injecting psychostimulants (5.1%) or personal needle or syringe reuse (5.2%). Participants from CALD backgrounds were more likely to report sharing needles or syringes (P = 0.004), and participants from Middle Eastern and North African backgrounds were less likely to have ever been tested for blood-borne viruses, compared with Anglo-Australian participants (P = 0.04). DISCUSSION AND CONCLUSIONS The findings show that some groups who inject IPEDs may be more vulnerable to blood-borne virus transmission and/or less likely to know their blood-borne virus status. From design to delivery, IPED harm minimisation strategies should pay attention to the needs of CALD groups.
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Affiliation(s)
- Rachel Rowe
- Drug and Alcohol Multicultural Education Centre, Sydney, Australia
| | - Israel Berger
- Drug and Alcohol Multicultural Education Centre, Sydney, Australia
| | - Bilal Yaseen
- Drug and Alcohol Multicultural Education Centre, Sydney, Australia
| | - Jan Copeland
- National Cannabis Prevention and Information Centre, UNSW Medicine, Sydney, Australia
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7
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Affiliation(s)
- Teresa M Wozniak
- NSW Public Health Officer Training Program, NSW Ministry of Health
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8
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Let It "B"? The role of Hepatitis B universal vaccination among italian problematic drug users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3979-92. [PMID: 25872013 PMCID: PMC4410228 DOI: 10.3390/ijerph120403979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 02/07/2023]
Abstract
Hepatitis B virus (HBV) hepatitis is extremely common among problematic drug users (DUs). As of 2012, 47 of the 53 European countries had implemented a universal hepatitis B vaccination programme, a scenario that could radically change its spread. Even so, drug users are still one of the main groups at risk of being infected by HBV, exposing the fact that universal vaccination still has not managed to reach an optimal level of contagion protection. In order to evaluate the role of universal HBV vaccination in protecting against risk behaviour related to the use of illicit drugs, a group of 748 DUs, 511 male and 237 female, was tested for HBV markers, at their first access to public addiction clinics in the metropolitan area of Bologna, Italy. 487 were born after 1981, so they were eligible to have received HBV vaccination in adolescence or at birth; in these subjects antibodies against HBV core antigen had the significant prevalence of 6.2%. Universal HBV vaccination has shown evidence of protecting against infection in the general population. These results, amongst the first to evaluate actual protection in DUs vaccinated at birth or during adolescence, show that compulsory universal vaccination does not solve the problem of HBV transmission in the most at risk groups and that additional strategies must be studied and implemented to address this issue.
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Fragomeli V, Weltman M. Addressing viral hepatitis in the opiate substitution setting: an integrated nursing model of care. J Gastroenterol Hepatol 2015; 30 Suppl 2:6-11. [PMID: 25641224 DOI: 10.1111/jgh.12864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Despite the availability of effective therapies for hepatitis C virus (HCV) and B virus (HBV), only a minority of infected patients receive treatment. In the general population, morbidity and mortality associated with chronic HCV is now successfully being addressed through the use of antiviral therapy. In Australia, an estimated 41% to 68% of people who inject drugs (PWID) are HCV positive, and between 28% and 59% of users are estimated to have been exposed to HBV. Although current treatment guidelines suggest that active drug use should not preclude people from HCV treatment, uptake of therapy thus far has been low. Patient, physician, social, and logistical-related barriers contribute to the low uptake of HCV treatment among PWID. Traditional means of managing HCV infection—referral to secondary or tertiary health centers—historically has a poor track record in increasing therapy uptake among this population. The same is true for people with chronic HBV who inject drugs. Close to 50,000 Australians receive opioid substitution therapy (OST) through a range of services, including public and private clinics, thus this setting is an ideal target for identifying and treating people at risk for and already infected with HBV and HCV. Over the last 11 years, a nursing model of care initiated by a teaching hospital in Sydney, Australia that integrates viral hepatitis screening, assessment, and treatment into the OST setting has enhanced access to services among the marginalized injecting drug use population.
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Affiliation(s)
- Vince Fragomeli
- Department of Gastroenterology and Hepatology Services, Nepean Hospital, Penrith, New South Wales, Australia
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Bailey SM, Oomkens B, Gilles MT. Hepatitis B vaccination in clients attending for opiate replacement therapy: Opportunism is key. Drug Alcohol Rev 2013; 32:550-1. [DOI: 10.1111/dar.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel Michael Bailey
- Western Australian Country Health Service-Midwest; Population Health; Geraldton; WA; Australia
| | - Bert Oomkens
- Western Australian Country Health Service-Midwest; Population Health; Geraldton; WA; Australia
| | - Marisa Theresa Gilles
- Western Australian Country Health Service-Midwest; Population Health; Geraldton; WA; Australia
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