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Minosse C, Salichos L, Taibi C, Luzzitelli I, Nardozi D, Capobianchi MR, D’Offizi G, McPhee F, Garbuglia AR. Phylogenetic and Phylodynamic Analyses of HCV Strains Circulating among Patients Using Injectable Drugs in Central Italy. Microorganisms 2021; 9:microorganisms9071432. [PMID: 34361868 PMCID: PMC8304011 DOI: 10.3390/microorganisms9071432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/13/2023] Open
Abstract
Approximately 71 million people worldwide are infected with the hepatitis C virus (HCV). Injectable drug use represents the most common route of transmission in Europe and other developed countries. We studied the molecular characteristics of the HCV infection among mono-infected people who used drugs (PWUD) in Italy. Among 208 PWUD with anti-HCV antibodies, 101 (48.6%) were HCV RNA-positive, the majority (47%) were infected with the HCV genotype (Gt)1a, followed by Gt3a (34.9%), Gt4 (9.1%), Gt1b (4.5%), and Gt2 (4.5%). Bayesian phylogenetic analyses of clustered HCV NS5B sequences from 66 HCV-positive PWUDs with available plasma samples indicated age and neighborhood proximity as the most common characteristics between closely related HCV strains. Population dynamics, as measured by a coalescent Bayesian skyline analysis, revealed an increase in HCV Gt1a infections from the mid-1980s to mid-1990s. While HCV Gt3a infections were first detected in the 1980s, patient numbers with this genotype subtype remained relatively constant. For both Gt1a and Gt3a, Birth–Death Bayesian Skyline analyses produced higher reproduction numbers post 2014. For earlier time intervals, slow growths were observed for both Gt1a and Gt3a with reproduction numbers (Re) of approximately 1. The evolutionary rates for Gt1a and Gt3a were estimated as 2.23 × 10−4 and 3.85 × 10−4, respectively.
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Affiliation(s)
- Claudia Minosse
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.M.); (D.N.); (M.R.C.)
| | - Leonidas Salichos
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06520, USA;
- Biological and Chemical Sciences, New York Institute of Technology, New York, NY 11568, USA
| | - Chiara Taibi
- Hepatology and Infectious Diseases Unit, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.T.); (I.L.); (G.D.)
| | - Ilaria Luzzitelli
- Hepatology and Infectious Diseases Unit, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.T.); (I.L.); (G.D.)
| | - Daniela Nardozi
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.M.); (D.N.); (M.R.C.)
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.M.); (D.N.); (M.R.C.)
| | - Gianpiero D’Offizi
- Hepatology and Infectious Diseases Unit, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.T.); (I.L.); (G.D.)
| | - Fiona McPhee
- Bristol-Myers Squibb Research and Development, Cambridge, MA 02142, USA;
| | - Anna Rosa Garbuglia
- Laboratory of Virology, “Lazzaro Spallanzani” National Institute for Infectious Diseases, IRCCS, 00149 Rome, Italy; (C.M.); (D.N.); (M.R.C.)
- Correspondence: ; Tel.: +39-06-55170692
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Rajabi A, Sharafi H, Alavian SM. Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis. Harm Reduct J 2021; 18:12. [PMID: 33482831 PMCID: PMC7825164 DOI: 10.1186/s12954-020-00441-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Prevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. Since 2005, the Iranian government has implemented a harm reduction program to control HCV. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the seroprevalence of HCV among PWID. We systematically reviewed the literature to identify eligible studies up to December 2018 in international and national databases. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed by harm reduction implementation and studies' characteristics to assess the sources of heterogeneity. We used Cochran-Armitage test for the linear trend of the prevalence of HCV Ab among PWID. RESULTS We reviewed 5966 papers and reports and extracted data from 62 eligible records. The pooled HCV Ab prevalence among PWID in Iran was 46.5% (95% confidence interval [95% CI] 41.1-52.0%). Overall, the Cochran-Armitage test for trend indicated a significant decreasing trend of HCV Ab prevalence (P = 0.04). The cumulative meta-analysis showed a slight decline in the prevalence of HCV Ab between the years 2005 and 2018. CONCLUSIONS The HCV Ab prevalence among PWID in Iran is high, with a considerable geographical variation. The prevalence of HCV Ab among PWID in Iran slightly decreased after 2005 which could be, at least to some extent, related to the implementation of extensive harm reduction programs in the country.
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Affiliation(s)
- Abdolhalim Rajabi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
- Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Middle East Liver Diseases (MELD) Center, Tehran, Iran.
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Rich KM, Bia J, Altice FL, Feinberg J. Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV? Curr HIV/AIDS Rep 2019; 15:266-275. [PMID: 29774442 PMCID: PMC6003996 DOI: 10.1007/s11904-018-0396-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose of Review To describe models of integrated and co-located care for opioid use disorder (OUD), hepatitis C (HCV), and HIV. Recent Findings The design and scale-up of multidisciplinary care models that engage, retain, and treat individuals with HIV, HCV, and OUD are critical to preventing continued spread of HIV and HCV. We identified 17 models within primary care (N = 3), HIV specialty care (N = 5), opioid treatment programs (N = 6), transitional clinics (N = 2), and community-based harm reduction programs (N = 1), as well as two emerging models. Summary Key components of such models are the provision of (1) medication-assisted treatment for OUD, (2) HIV and HCV treatment, (3) HIV pre-exposure prophylaxis, and (4) behavioral health services. Research is needed to understand differences in effectiveness between co-located and fully integrated care, combat the deleterious racial and ethnic legacies of the “War on Drugs,” and inform the delivery of psychiatric care. Increased access to harm reduction services is crucial. Electronic supplementary material The online version of this article (10.1007/s11904-018-0396-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine M Rich
- Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Joshua Bia
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Frederick L Altice
- Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA.,Centre of Excellence on Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry and Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
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Paraschiv S, Banica L, Nicolae I, Niculescu I, Abagiu A, Jipa R, Pineda-Peña AC, Pingarilho M, Neaga E, Theys K, Libin P, Otelea D, Abecasis A. Epidemic dispersion of HIV and HCV in a population of co-infected Romanian injecting drug users. PLoS One 2017; 12:e0185866. [PMID: 29016621 PMCID: PMC5633171 DOI: 10.1371/journal.pone.0185866] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022] Open
Abstract
Co-infections with HIV and HCV are very frequent among people who inject drugs (PWID). However, very few studies comparatively reconstructed the transmission patterns of both viruses in the same population. We have recruited 117 co-infected PWID during a recent HIV outbreak in Romania. Phylogenetic analyses were performed on HIV and HCV sequences in order to characterize and compare transmission dynamics of the two viruses. Three large HIV clusters (2 subtype F1 and one CRF14_BG) and thirteen smaller HCV transmission networks (genotypes 1a, 1b, 3a, 4a and 4d) were identified. Eighty (65%) patients were both in HIV and HCV transmission chains and 70 of those shared the same HIV and HCV cluster with at least one other patient. Molecular clock analysis indicated that all identified HIV clusters originated around 2006, while the origin of the different HCV clusters ranged between 1980 (genotype 1b) and 2011 (genotypes 3a and 4d). HCV infection preceded HIV infection in 80.3% of cases. Coincidental transmission of HIV and HCV was estimated to be rather low (19.65%) and associated with an outbreak among PWID during detention in the same penitentiary. This study has reconstructed and compared the dispersion of these two viruses in a PWID population.
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Affiliation(s)
- Simona Paraschiv
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
- * E-mail:
| | - Leontina Banica
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
| | - Ionelia Nicolae
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
| | - Iulia Niculescu
- Clinical Department, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
- SMZ Süd—Kaiser-Franz-Josef-Spital, 4. Med. Abteilung, Vienna, Austria
| | - Adrian Abagiu
- Clinical Department, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
| | - Raluca Jipa
- Clinical Department, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
| | - Andrea-Clemencia Pineda-Peña
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC) and Basic Sciences Department, Universidad del Rosario, Bogotá, Colombia
| | - Marta Pingarilho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Emil Neaga
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
| | - Kristof Theys
- KU Leuven—University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
| | - Pieter Libin
- KU Leuven—University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Artificial Intelligence lab, Department of computer science, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dan Otelea
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases ‘Matei Bals’, Bucharest, Romania
| | - Ana Abecasis
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- KU Leuven—University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
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Estimating the cascade of hepatitis C testing, care and treatment among people who inject drugs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:77-85. [DOI: 10.1016/j.drugpo.2017.05.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/04/2017] [Accepted: 05/05/2017] [Indexed: 01/16/2023]
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Martin-Subero M, Diez-Quevedo C. Mental disorders in HIV/HCV coinfected patients under antiviral treatment for hepatitis C. Psychiatry Res 2016; 246:173-181. [PMID: 27718466 DOI: 10.1016/j.psychres.2016.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/27/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
This paper aims to review the epidemiology and management of mental disorders in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the need for antiviral therapy in this specific population, and current treatment strategies for HIV/HCV patients with psychiatric and/or substance use disorders. This is a narrative review. Data was sourced from electronic databases and was not limited by language or date of publication. HIV infection has become a survivable chronic illness. Prevalence of HCV infection among HIV-infected patients is high ranging from 50% to 90%. Patients with psychiatric diseases have also an increased risk for HIV/HCV coinfection. The most effective strategy to decrease HCV-related morbidity and mortality in coinfection is to achieve viral eradication. Although psychiatric symptoms often appear during antiviral treatment and may be associated with the use of interferon-alpha (IFN-α), recent evidence suggests that many patients with comorbid mental and substance use disorders can be treated safely. Recent data indicate that IFNα-induced psychiatric side effects have a similar prevalence in HIV/HCV coinfected patients than in monoinfected patients and they can be managed and even prevented successfully with psychopharmacological strategies in the frame of a multidisciplinary team. New antivirals offer INF-free therapies for this specific population.
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Affiliation(s)
- Marta Martin-Subero
- FIDMAG Research Foundation, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Badalona, Spain.
| | - Crisanto Diez-Quevedo
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Badalona, Spain; Department of Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany. PLoS One 2015; 10:e0142515. [PMID: 26555244 PMCID: PMC4640863 DOI: 10.1371/journal.pone.0142515] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/22/2015] [Indexed: 12/14/2022] Open
Abstract
Objectives Men who have sex with men (MSM) are at higher risk for coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis than the general population. HIV infection and these coinfections accelerate disease progression reciprocally. This study evaluated the prevalence and incidence of these coinfections in HIV1-positive MSM in Germany. Materials and Methods As part of a nationwide, multicenter, prospective cohort study of HIV-infected MSM, plasma samples collected yearly were screened for HBsAg and antibodies to HBc, HBs, HCV, and syphilis. Samples with indications of active HBV or HCV infection were confirmed by polymerase chain reaction. Prevalence and incidence of each infection and incidence rates per study participant were calculated, and incidences over 4-year time intervals compared. Results This study screened 5,445 samples from 1,843 MSM. Median age at HIV seroconversion was 33 years. Prevalences of active, cleared, and occult HBV, and of active/cleared HCV were 1.7%, 27.1%, 0.2%, and 8.2%, respectively, and 47.5% had been effectively vaccinated against HBV. Prevalence of antibodies to Treponema pallidum and of triple or quadruple sexually transmitted infections (STIs) were 39.6% and 18.9%, respectively. Prevalence of STI, cleared HBV, HBV vaccination, and history of syphilis differed significantly among age groups. Incidences of HBV, HCV, and syphilis were 2.51, 1.54, and 4.06 per 100 person-years, respectively. Incidences of HCV and syphilis increased over time. HCV incidence was significantly higher in MSM coinfected with syphilis and living in Berlin, and syphilis incidence was significantly higher for MSM living in Berlin. Discussion Despite extensive HBV vaccination campaigns, fewer than 50% of screened MSM were effectively vaccinated, with a high proportion of HIV-positive MSM coinfected with HBV. High rates of STI coinfections in HIV-positive MSM and increasing incidences emphasize the need for better tailored campaigns for HBV vaccination and STI prevention.
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Malekinejad M, Navadeh S, Lotfizadeh A, Rahimi-Movaghar A, Amin-Esmaeili M, Noroozi A. High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001-2012). Int J Infect Dis 2015; 40:116-30. [PMID: 26460088 PMCID: PMC8741151 DOI: 10.1016/j.ijid.2015.09.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Drug users, particularly drug injectors, are at elevated risk of blood-borne diseases. This study systematically reviewed the prevalence of hepatitis C virus (HCV) mono-infection and its co-infections with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in drug users in Iran. METHODS Searches were conducted in international, regional, and Iranian databases. Documents were screened, data extracted, and pooled point prevalence and 95% confidence intervals (CI) were calculated. RESULTS Overall, 13,821 subjects (87.4% male) with an average age of 32.4 years (95% CI 31-33 years) from 24 original studies were included in the analysis. The pooled HCV prevalence (95% CI) among drug users with and without an injection history was 45% (37-54%) and 8% (4-13%), respectively. The pooled HCV prevalences (95% CI) among individuals with vs. without a history of imprisonment and needle sharing were 58% (39-77%) vs. 44% (20-68%) and 56% (41-71%) vs. 49% (26-71%), respectively. The prevalence of HCV/HIV co-infection among injectors was 11% (95% CI 5-16%). CONCLUSIONS HCV prevalence is high in drug users in Iran, especially among those with a history of injection drug use, needle sharing, and imprisonment. Drug user-focused HCV prevention and treatment programs are urgently needed.
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Affiliation(s)
- Mohsen Malekinejad
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA; Global Health Sciences, University of California, 3333 California Street, Suite 265, San Francisco, CA 94118, USA.
| | - Soodabeh Navadeh
- Global Health Sciences, University of California, 3333 California Street, Suite 265, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Lotfizadeh
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Latypov A, Grund JP, El-Bassel N, Platt L, Stöver H, Strathdee S. Illicit drugs in Central Asia: what we know, what we don’t know, and what we need to know. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 25:1155-62. [PMID: 25449055 DOI: 10.1016/j.drugpo.2014.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Luhmann N, Champagnat J, Golovin S, Maistat L, Agustian E, Inaridze I, Myint WM, Butsashvili M, Bouscaillou J. Access to hepatitis C treatment for people who inject drugs in low and middle income settings: Evidence from 5 countries in Eastern Europe and Asia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1081-7. [PMID: 26342273 DOI: 10.1016/j.drugpo.2015.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/08/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are disproportionately affected by the hepatitis C (HCV) epidemic. Of the estimated 16 million PWID worldwide, approximately 8 million live with chronic HCV, and around 26% and 23% of the global HCV infections among PWID occur in East/Southeast Asia and Eastern Europe respectively. Globally, few PWID have access to treatment for HCV. METHODS We conducted a systematic literature review and internet survey in 2014 to document the burden of disease, access to diagnosis and treatment and the existence of national policy and treatment guidelines for HCV. We included Georgia, Russia, Ukraine, Myanmar and Indonesia as countries with injection drug use epidemics. FINDINGS HCV antibody prevalence among the general population ranged from 0.80% in Indonesia to 5% in Georgia, and among PWID from 48.1% in Myanmar to 92% in Georgia. PWID carried a significant burden of disease, ranging from 2.7% in Indonesia to 40.4% in Russia. Yearly treatment uptake was under 1% for the general population and PWID in all countries. Diagnostic tools and disease staging investigations as well as pegylated interferon/ribavirin treatment were available at a range of prices. Despite policy and treatment protocols for HCV in the majority of countries, strategies focusing on PWID were largely absent. CONCLUSION PWID are a priority group for treatment, and access to treatment should be based on sound national policy, accessible public treatment programmes and functional surveillance systems.
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Affiliation(s)
- Niklas Luhmann
- Médecins du Monde France, 62 rue Marcadet, 75018, Paris, France.
| | | | - Sergey Golovin
- International Treatment Preparedness Coalition in Eastern Europe and Central Asia, Dostoevskogo 38-30, St. Petersburg, Russia
| | - Ludmila Maistat
- International HIV/AIDS Alliance in Ukraine, 5 Dymytrova St., Build 10A, 03680 Kyiv, Ukraine
| | - Edo Agustian
- Indonesian Drug User Network Persaudaraan Korban Napza (PKNI), Jalan Tebet Timur Dalam XI No. 94 Tebet, Jakarta Selatan 12820, Indonesia
| | - Ina Inaridze
- Médecins du Monde Georgia, 46 Street, Gutani, Tbilisi, 0179, Georgia
| | - Wai Moe Myint
- Médecins du Monde Myanmar, No (11-B) Maharmyaing Street, Sanchaung Township, Yangon, Myanmar
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DeHovitz J, Uuskula A, El-Bassel N. The HIV epidemic in Eastern Europe and Central Asia. Curr HIV/AIDS Rep 2015; 11:168-76. [PMID: 24652411 DOI: 10.1007/s11904-014-0202-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eastern Europe and Central Asia represent one of the few regions globally where there is a continued increase in the incidence of HIV infection. For example, in Eastern Europe the rate of diagnosed cases of HIV infection per 100 000 population has increased from 11.7 in 2004 to 22.5 in 2011. Initially propelled by injection drug use, heterosexual transmission has now become a major driver of new infections in the region. Nonetheless substance use remains an important factor, with its control limited by challenges in scaling up harm reduction efforts. While most countries have implemented opioid substitution therapy programs, their scale remains very limited. Similarly, coverage of needles syringe programs across the region is variable. Complicating the control of HIV has been the emergence of non-injection drugs and inadequate access to antiretroviral therapy. In addition, structural barriers and stigma toward HIV infected people may contribute to the high proportion of late presentations for HIV care. Finally in the wake of the HIV epidemic, high rates of hepatitis C infection and tuberculosis have been noted.
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Affiliation(s)
- Jack DeHovitz
- SUNY Downstate Medical Center, 450 Clarkson Ave., MSC 1240, Brooklyn, NY, 11203, USA,
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White B, Dore GJ, Lloyd AR, Rawlinson WD, Maher L. Opioid substitution therapy protects against hepatitis C virus acquisition in people who inject drugs: the HITS-c study. Med J Aust 2014; 201:326-9. [PMID: 25222455 DOI: 10.5694/mja13.00153] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/05/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate hepatitis C virus (HCV) incidence and identify associated risk and protective factors among people who inject drugs (PWID) in Sydney, New South Wales. DESIGN, SETTING AND PARTICIPANTS Community-based prospective observational study of serologically confirmed HCV antibody-negative PWID enrolled in six Sydney neighbourhoods located in three distinct regions between 10 November 2008 and 31 October 2011. MAIN OUTCOME MEASURES Serologically confirmed HCV incidence per person-years (py); and self-reported demographic and behavioural risk factors for HCV infection. RESULTS The overall incidence of HCV infection was 7.9/100 py. Risk factors independently associated with incident HCV infection were younger age (adjusted hazard ratio [AHR] for age < 27 years, 5.66; 95% CI, 1.69-18.95; P = 0.005) and daily or more frequent injecting (AHR, 4.06; 95% CI, 1.15-14.30; P = 0.03). Opioid substitution therapy (OST) was protective against HCV seroconversion and was associated with a reduced risk of incident infection among those who mainly injected heroin or other opioids (AHR for those not receiving OST while mainly injecting heroin or other opioids, 5.64; 95% CI, 1.30-24.42; P = 0.02). CONCLUSION The observed HCV incidence was substantially lower than the incidence of 30.8/100 py observed a decade earlier in a similar NSW-based cohort, suggesting a decline in HCV incidence among PWID. This is likely due to increased coverage of OST, combined with a probable decrease in the population of PWID.
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Affiliation(s)
- Bethany White
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - William D Rawlinson
- Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Lisa Maher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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El-Bassel N, Gilbert L, Terlikbayeva A, Beyrer C, Wu E, Shaw SA, Ma X, Chang M, Hunt T, Ismayilova L, Primbetova S, Rozental Y, Zhussupov B. HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: implications for HIV prevention, research, and policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:1195-203. [PMID: 24556208 PMCID: PMC5859567 DOI: 10.1016/j.drugpo.2013.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. METHODS This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. RESULTS The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01). CONCLUSION Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.
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Affiliation(s)
- Nabila El-Bassel
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States.
| | - Louisa Gilbert
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
| | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E7141, Baltimore, MD 21205, United States
| | - Elwin Wu
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Stacey A Shaw
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Xin Ma
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Mingway Chang
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Tim Hunt
- Global Health Research Center of Central Asia, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, United States
| | - Leyla Ismayilova
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, United States
| | - Sholpan Primbetova
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
| | - Yelena Rozental
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
| | - Baurzhan Zhussupov
- Global Health Research Center of Central Asia, 102 Luganskogo Street, ap. 1, Medeu District, Almaty 050059, Kazakhstan
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Assessing the feasibility of hepatitis C virus vaccine trials: results from the Hepatitis C Incidence and Transmission Study-community (HITS-c) vaccine preparedness study. Vaccine 2014; 32:5460-7. [PMID: 25131726 DOI: 10.1016/j.vaccine.2014.07.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/07/2014] [Accepted: 07/30/2014] [Indexed: 12/26/2022]
Abstract
Efficacy trials of preventive hepatitis C virus (HCV) vaccine candidates raise challenging scientific and ethical issues. Based on data from the first 3 years of a community-based prospective observational study - the Hepatitis C Incidence and Transmission Study-community (HITS-c) - this paper examines the feasibility of conducting trials of candidate HCV vaccines with people who inject drugs (PWID) in Sydney, Australia. Of the 166 PWID confirmed HCV antibody negative and eligible for enrolment, 156 (94%) completed baseline procedures. Retention was high, with 89% of participants retained at 48 weeks and 76% of participants completing at least 75% of study visits within 2 weeks of schedule. The rate of primary HCV infection was 7.9/100 py (95% CI 4.9, 12.7). Of the 17 incident cases, 16 completed at least one follow-up assessment and 12 (75%) had evidence of chronic viraemia with progression to chronic HCV infection estimated to be 6/100 py. Power calculations suggest a chronic HCV infection rate of at least 12/100 py (primary HCV infection rate 16/100 py) will be required for stand-alone trials of highly efficacious candidates designed to prevent chronic infection. However, elevated primary HCV infection was observed among participants not receiving opioid substitution therapy who reported heroin as the main drug injected (26.9/100 py, 95% CI 14.5, 50.0) and those who reported unstable housing (23.5/100 py, 95% CI 7.6, 72.8), daily or more frequent injecting (22.7/100 py, 95% CI 12.2, 42.2) and receptive syringe sharing (23.6/100 py, 95% CI 9.8, 56.7) in the 6 months prior to baseline. These data suggest that it is possible to recruit and retain at-risk PWID who adhere to study protocols and that modification of eligibility criteria may identify populations with sufficiently high HCV incidence. Results support the feasibility of large multi-centre HCV vaccine trials, including in the Australian setting.
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15
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El-Bassel N, Strathdee SA, El Sadr WM. HIV and people who use drugs in central Asia: confronting the perfect storm. Drug Alcohol Depend 2013; 132 Suppl 1:S2-6. [PMID: 23953656 PMCID: PMC4006578 DOI: 10.1016/j.drugalcdep.2013.07.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 01/14/2023]
Affiliation(s)
- Nabila El-Bassel
- Global Health Research Central of Central Asia, Columbia University School of Social Work, New York, NY, United States.
| | | | - Wafaa M. El Sadr
- ICAP at Columbia University Mailman School of Public Health, College of Physicians and Surgeons, New York, NY, United States
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16
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Walsh N, Maher L. HIV and HCV among people who inject drugs in Central Asia. Drug Alcohol Depend 2013; 132 Suppl 1:S37-40. [PMID: 23906997 DOI: 10.1016/j.drugalcdep.2013.06.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Over the last decade, Central Asia has become a focal point of HIV and hepatitis C virus (HCV) transmission among people who inject drugs (PWID). PWID account for the majority of HIV infections in most countries in the region, while a large proportion have been exposed to HCV. Shared modes of transmission of these infections point to an increasing burden of HIV/HCV co-infection in this population. HIV/HCV co-infection is more likely to result in progressive liver disease, increased mortality and hepatic complications from antiretroviral therapy (ART). While the HIV treatment response has improved, less than a quarter of people living with HIV (PLHIV) in the region are receiving ART, with treatment uptake among PWID particularly low. HCV treatment is available in some areas, though at a very high cost to patients thereby preventing access to those at most need. CONCLUSION Robust surveillance of HIV/HCV infection among PWID is needed to inform a comprehensive response to HIV and HCV prevention and treatment among PWID, including increasing coverage of opioid substitution therapy (OST) and needle and syringe programs (NSPs), improving access and uptake of ART, and lowering costs and other barriers to HCV treatment across the five republics. Optimising uptake of these initiatives by increasing prevention and treatment literacy among PWID and decreasing barriers to screening and testing will also be necessary to mitigate the increasing burden of HIV/HCV co-infection in the region.
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Affiliation(s)
- Nick Walsh
- Department of Epidemiology and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne 3004, Australia.
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17
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Taylor LE, Swan T, Matthews GV. Management of hepatitis C virus/HIV coinfection among people who use drugs in the era of direct-acting antiviral-based therapy. Clin Infect Dis 2013; 57 Suppl 2:S118-24. [PMID: 23884059 PMCID: PMC3722078 DOI: 10.1093/cid/cit326] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Where active antiretroviral therapy (ART) is accessible, human immunodeficiency virus (HIV) is a survivable illness and effective ART can reduce HIV transmission. Chronic hepatitis C virus (HCV) has emerged as a threat to the survival of individuals harboring both HCV and HIV, due to high prevalence and aggressive disease course. The HCV/HIV coinfection epidemic has been driven by people who inject drugs (PWID), although incident HCV is rising among HIV-infected men who have sex with men in the absence of drug injection. Coinfected individuals warrant aggressive treatment of both viruses; although early ART initiation is recommended to reduce the rate of liver disease progression, the most effective way to decrease HCV-related morbidity and mortality in coinfection is to achieve HCV viral eradication. Direct-acting antiviral (DAA) agents will soon revolutionize HCV treatment. Clinical data are needed regarding the efficacy of DAAs in coinfected PWID. Drug-drug interaction studies between ART, DAAs, and opiate substitution therapy must be expedited. Coinfected PWID should have equitable and universal access to HIV/AIDS, HCV, and addiction prevention, care, and treatment. Essential basic steps include improving screening for both infections and engaging coinfected PWID in HIV and HCV care early after diagnoses. Developing strategies to expand access to HCV therapy for coinfected PWID is imperative to stem the HCV epidemic and limit the morbidity and mortality of those at greatest risk for HCV disease progression. The ultimate goal must be the elimination of HCV from all coinfected PWID.
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Affiliation(s)
- Lynn E Taylor
- Department of Medicine, Brown University, Providence, Rhode Island, USA.
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18
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Huik K, Avi R, Carrillo A, Harper N, Pauskar M, Sadam M, Karki T, Krispin T, Kongo UK, Jermilova T, Rüütel K, Talu A, Abel-Ollo K, Uusküla A, Ahuja SK, He W, Lutsar I. CCR5 haplotypes influence HCV serostatus in Caucasian intravenous drug users. PLoS One 2013; 8:e70561. [PMID: 23936229 PMCID: PMC3723663 DOI: 10.1371/journal.pone.0070561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/23/2013] [Indexed: 01/28/2023] Open
Abstract
Background Up to 90% HIV-1 positive intravenous drug users (IDUs) are co-infected with HCV. Although best recognized for its function as a major co-receptor for cell entry of HIV, CC chemokine receptor 5 (CCR5) has also been implicated in the pathogenesis of HCV infection. Here, we investigated whether CCR5 haplotypes influence HIV-1 and HCV seropositivity among 373 Caucasian IDUs from Estonia. Methods Of these IDUs, 56% and 44% were HIV and HCV seropositive, respectively, and 47% were coinfected. 500 blood donors seronegative for HIV and HCV were also evaluated. CCR5 haplotypes (HHA to HHG*2) were derived after genotyping nine CCR2–CCR5 polymorphisms. The association between CCR5 haplotypes with HIV and/or HCV seropositivity was determined using logistic regression analysis. Co-variates included in the models were length of intravenous drug use, HBV serostatus and copy number of CCL3L1, the gene encoding the most potent HIV-suppressive chemokine and ligand for CCR5. Results Compared to IDUs seronegative for both HCV and HIV (HCV−/HIV-), IDUs who were HCV+/HIV- and HCV+/HIV+were 92% and 82%, respectively, less likely to possess the CCR5-HHG*1 haplotype, after controlling for co-variates (Padjusted = 1.89×10−4 and 0.003, respectively). This association was mostly due to subjects bearing the CCR5 HHE and HHG*1 haplotype pairs. Approximately 25% and<10% of HCV−/HIV- IDUs and HCV−/HIV- blood donors, respectively, possessed the HHE/HHG*1 genotype. Conclusions Our findings suggest that HHG*1-bearing CCR5 genotypes influence HCV seropositivity in a group of Caucasian IDUs.
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MESH Headings
- Adult
- Chemokines, CC/blood
- Chemokines, CC/genetics
- Chemokines, CC/immunology
- Coinfection
- Estonia/epidemiology
- Female
- Gene Expression
- HIV Seropositivity/epidemiology
- HIV Seropositivity/ethnology
- HIV Seropositivity/genetics
- HIV Seropositivity/virology
- HIV-1/isolation & purification
- Haplotypes
- Hepacivirus/isolation & purification
- Hepatitis C, Chronic/ethnology
- Hepatitis C, Chronic/genetics
- Hepatitis C, Chronic/immunology
- Hepatitis C, Chronic/virology
- Humans
- Male
- Prevalence
- Receptors, CCR5/blood
- Receptors, CCR5/genetics
- Receptors, CCR5/immunology
- Substance Abuse, Intravenous/ethnology
- Substance Abuse, Intravenous/genetics
- Substance Abuse, Intravenous/immunology
- Substance Abuse, Intravenous/virology
- White People
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Affiliation(s)
- Kristi Huik
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Radko Avi
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Andrew Carrillo
- Veterans Administration Research Center for AIDS and HIV-1 Infection, and Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Texas, United States of America
- Departments of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Nathan Harper
- Veterans Administration Research Center for AIDS and HIV-1 Infection, and Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Texas, United States of America
- Departments of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Merit Pauskar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Maarja Sadam
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tõnis Karki
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tõnu Krispin
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Ulvi-Kaire Kongo
- Immunoheamatology Reference Laboratory, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | - Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - Ave Talu
- National Institute for Health Development, Tallinn, Estonia
| | | | - Anneli Uusküla
- Department of Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Sunil K. Ahuja
- Veterans Administration Research Center for AIDS and HIV-1 Infection, and Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Texas, United States of America
- Departments of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Weijing He
- Veterans Administration Research Center for AIDS and HIV-1 Infection, and Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Texas, United States of America
- Departments of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
- * E-mail: (WH); (IL)
| | - Irja Lutsar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
- * E-mail: (WH); (IL)
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