High prevalence of hepatitis C virus infection in Belgian intravenous drug users and potential role of the "cotton-filter" in transmission: the GEMT Study.
OBJECTIVE
To estimate viral seroprevalences for HCV, HBV and HIV among belgian intravenous (IVDU) and non intravenous (non-IVDU) drug users; to assess risk factors for HCV infection in IVDU; to assess feasibility of chronic hepatitis C follow-up in this population.


METHODS
Cross-sectional study. Demographic and behavioural characteristics were obtained by a standardized questionnaire. Serum samples were tested for HCV, HBV and HIV.


METHODS
329 patients (244 IVDU and 85 non-IVDU) attending ten general practitioners in 1995.


RESULTS
HCV seroprevalence was 78.3%; it was 35.7% for HBV and 0.9% for HIV in IVDU, vs 2.4%, 8.3% and 0%, respectively, in non-IVDU. In logistic regression analysis, independent risk factors for HCV infection were: 1/sharing of syringes and/or of "cottons" used as filters (adjusted prevalence odds ratio [POR] = 31.7; 95% confidence interval [CI] = 9.8-102.5), 2/duration of injecting upper than one month (adjusted POR = 8.6; CI = 3.0-24.7) and 3/age (adjusted POR = 1.2 by year of difference; CI = 1.0-1.3). A biochemical follow-up was obtained in 70% of HCV seropositive users; 79.5% of them had chronic hepatitis C (mean value of ALT = 3.5 times upper normal value, range 1.1-23.0). Among these, 24.7% went through liver biopsy during the three years follow-up period of the study.


CONCLUSIONS
HCV seroprevalence is very high among belgian IVDU. Prevention strategies have to focus on neophytes injectors. They must be urgently revisited for what concern needles/syringes exchange programs: "cottons" must be included. Follow-up and treatment of chronic hepatitis C seem to be poorly effective among drug users.
Denis
B
B
Hospital St Joseph, Gilly.
Dedobbeleer
M
M
Collet
T
T
Petit
J
J
Jamoulle
M
M
Hayani
A
A
Brenard
R
R
D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007275:Injections, Intravenous / Q000295:instrumentation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018671:Needle-Exchange Programs / Q000458:organization & administration; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires