title: 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.
abstract: 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.
authors.affiliation: Department of Medical Microbiology, University of Lund, University Hospital, Malmö, Sweden.
authors.forename: A S
authors.initials: AS
authors.lastname: Månsson
authors.forename: T
authors.initials: T
authors.lastname: Moestrup
authors.forename: E
authors.initials: E
authors.lastname: Nordenfelt
authors.forename: A
authors.initials: A
authors.lastname: Widell
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D015819:Substance Abuse, Intravenous; D013548:Sweden / Q000453:epidemiology; D014505:Urban Population