HIV and hepatitis virus infections among injecting drug users in a medically controlled heroin prescription programme.
BACKGROUND
In Switzerland, 1,035 patients were accepted for admission to the medically controlled prescription of narcotics programme (PROVE) from 1 January 1994 until 31 December 1996. Heroin, methadone, and morphine were prescribed. This paper presents the prevalence and incidence of HIV and hepatitis B/C infections in the sociomedical context of the participants.


METHODS
Admission criteria were a minimum age of 20 years, at least a two-year duration of daily heroin consumption, a negative outcome of at least two previous treatments, and documented social and health deficits as a consequence of their heroin dependence. The patients were examined at admission and every six months. A serological test was carried out at the same time for HIV and hepatitis B/C.


RESULTS
Serological testing on admission could be performed in more than 80% of the entrants and documented a very high seroprevalence of antibodies against HBcore (73%) and HCV (82%). The prevalence of HIV and hepatitis B/C increased with duration of drug intake. In the follow-up analysis of seronegative individuals, a halving of the risk of viral hepatitis infection was shown when comparing the first six months with the period greater then six months after PROVE entry.


CONCLUSIONS
The tests conducted showed high prevalence and incidence rates of HIV and hepatitis B/C among patients who had consumed intravenous drugs for years. The descriptive analysis in heroin-assisted treatment showed a reduction in infection risk for viral hepatitis corresponding to the lower risk behaviour of patients.
Steffen
T
T
Addiction Research Institute, Zurich, Switzerland. thomas_steffen@bluewin.ch
Blättler
R
R
Gutzwiller
F
F
Zwahlen
M
M
D000328:Adult; D011307:Drug Prescriptions; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology; D006291:Health Policy; D006509:Hepatitis B / Q000453:epidemiology* / Q000209:etiology; D006526:Hepatitis C / Q000453:epidemiology* / Q000209:etiology; D003932:Heroin / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D009020:Morphine / Q000008:administration & dosage; D015995:Prevalence; D015980:Public Health Practice; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D013557:Switzerland / Q000453:epidemiology
D003932:Heroin; D009020:Morphine; D008691:Methadone