title: Implications of hepatitis C viremia vs. antibody alone on transmission among male injecting drug users in three Afghan cities.
abstract: OBJECTIVE
  To assess differences between injecting drug users (IDUs) with hepatitis C virus (HCV) viremia and IDUs with HCV antibody (Ab) or no evidence of prior infection in three Afghan cities.
  
  
  METHODS
  IDUs in Hirat, Jalalabad, and Mazar-i-Sharif completed questionnaires and rapid testing for blood-borne infections including HCV Ab. HCV Ab was confirmed with a recombinant immunoblot assay (RIBA); RIBA-positive specimens underwent reverse transcriptase polymerase chain reaction (RT-PCR) for HCV. Risk behaviors associated with viremia were assessed with site-controlled ordinal regression analysis.
  
  
  RESULTS
  Of 609 participants, 223 (36.6%) had confirmed HCV Ab. Of 221 with serum available for PCR evaluation, 127 (57.5%) were viremic. HCV viremia prevalence did not differ by site (range 41.7-59.1%; p=0.52). Among all IDUs, in age and site-controlled ordinal regression analysis, HCV was independently associated with HIV co-infection (adjusted odds ratio (AOR) 7.16, 95% confidence interval (CI) 4.41-11.64), prior addiction treatment (AOR 1.95, 95% CI 1.57-2.42), ever aspirating and re-injecting blood (AOR 1.62, 95% CI 1.18-2.23), prior incarceration (AOR 1.60, 95% CI 1.04-2.45), and sharing injecting equipment in the last 6 months (AOR 1.35, 95% CI 1.02-1.80).
  
  
  CONCLUSIONS
  HCV viremia was present in many participants with prior HCV infection and was associated with some injecting risk behaviors, indicating a substantial risk for transmission. Current harm reduction programs should aim to improve HCV awareness and prevention among IDUs in Afghanistan as a matter of urgency.
authors.affiliation: International Rescue Committee, Kabul, Afghanistan.
authors.forename: Abdul
authors.initials: A
authors.lastname: Nasir
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Stanekzai
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.forename: Boulos A
authors.initials: BA
authors.lastname: Botros
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Kim
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tjaden
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious; D006526:Hepatitis C / Q000276:immunology / Q000635:transmission*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D015151:Immunoblotting; D008297:Male; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000821:virology*; D011795:Surveys and Questionnaires; D014766:Viremia / Q000276:immunology / Q000635:transmission*
chemical_list: D018937:Hepatitis C Antibodies