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among injecting drug users in Australia . Epidemiology of hepatitis C virus infection
| Content Provider | Semantic Scholar |
|---|---|
| Author | Crofts, Nick Jolley, Damien Kaldor, John K. Beek, Ingrid Van Wodak, Alex |
| Abstract | Study objective-To review the epidemiology of hepatitis C virus (HCV) infection among injecting drug users (IDUs) in Australia, and consider needs for further research and prevention policies and programmes. Design-(1) Review of the results of surveillance for HCV; (2) review of published literature on prevalence, incidence, and risk factors for HCV among IDUs; and (3) reconstruction of incidence rates from prevalence studies of HCV in IDUs. Setting and Participants-Field and clinic based studies ofIDUs in Australia. Main results-HCV has been present at high prevalences (of the order of 60-70%) in populations ofAustralian IDUs since at least 1971. Duration of injecting and main drug injected were the main predictors of seropositivity, the latter possibly a surrogate for frequency of injecting and both together as surrogate for cumulative numbers of times injected. Risk of infection begins with first injection and continues as long as injecting does. Current incidence is approximately 15 per 100 person years, and up to 40 per 100 person years in some subpopulations. Incidence may have decreased through the 1980s as a result of behaviour change in relation to HIV, as it has for hepatitis B, but not significantly so. Conclusions-Control ofHCV infection in Australia will depend on effectiveness of measures to control HCV spread among IDUs. This will be a greater challenge than the control of HIV in this population has been. Needs identified include improved surveillance, especially for recently acquired infection, better understanding of exact transmission modes, and urgent improvement in prevention strategies. (7 Epidemiol Community Health 1997;51:692-697) Since the identification of hepatitis C virus (HCV) in 1989' and the availability of assays for the detection of antibody to HCV in 1990,2 the epidemiology of HCV infection has been investigated in many populations. The major group infected and at risk of continuing infection with HCV in Australia, as in other developed countries, is people who currently or previously injected or had been injected with illicit drugs.3 This increased risk is associated with the practice of sharing of equipment used in injecting; especially needles and syringes, as is the case also with hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Other exposures that have been found to be important are the receipt of contaminated blood or blood products,4 tattooing,5 and dental procedures.6 Since the introduction of universal donor screening for HCV antibody in 1990, transmission through the blood supply has become rare.7 It is currently estimated that over 80% of those exposed to HCV will become carriers,8 at risk of long term disease including cirrhosis and hepatocellular carcinoma.9 While actual rates are still unclear, it is possible that 20% or more of those chronically infected will develop such disease over 20 years or more.'0 The only available treatment, alfa interferon, is ineffective in most patients and is specifically not available to current injecting drug users (IDUs) in Australia." Prospects of a vaccine against HCV are not promising in the short-term. 12 There have been a number of surveys of different populations of IDUs in Australia for HCV exposure. Surveillance for diagnosed HCV infection at a national level was introduced and has been gradually refined since testing began in 1990. To establish as complete a picture as possible of the pattern of HCV infection among IDUs in Australia, we undertook a review of available epidemiological data. We have also sought to identify research needs and opportunities, and effectiveness of and requirements for further prevention programmes to decrease its spread in these populations. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://jech.bmj.com/content/jech/51/6/692.full.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
