title: Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment.
abstract: OBJECTIVE
  We conducted a systematic review of studies reporting seroincidence of hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified published and unpublished studies that met inclusion criteria.
  
  
  METHODS
  We estimated the relative contributions of shared syringes and drug preparation equipment to HCV transmission using random-effects meta-analysis, and analyzed potential sources of heterogeneity of effects among studies.
  
  
  RESULTS
  Syringe sharing was associated with HCV seroconversion [pooled risk ratio (PRR) = 1.94, 95% confidence interval (CI) 1.53, 2.46], as was sharing drug preparation containers (PRR = 2.42, 95% CI 1.89, 3.10), filters (PRR = 2.61, 95% CI 1.91, 3.56), rinse water (PRR = 1.98, 95% CI 1.54, 2.56), combinations of this equipment (PRR = 2.24, 95% CI 1.28, 3.93) and 'backloading', a syringe-mediated form of sharing prepared drugs (PRR = 1.86, 95% CI 1.41, 2.44). Meta-regression results showed that the association between syringe sharing and seroconversion was modified by HCV seroprevalence in the IDU populations.
  
  
  CONCLUSIONS
  The risk of hepatitis C infection through shared syringes is dependent upon hepatitis C infection seroprevalence in the population. The risk of hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Because the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide or inject drugs and avoid backloading with an unsterile syringe.
authors.affiliation: National Development and Research Institutes, Inc., New York, NY 10010, USA. pouget@ndri.org
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Pouget
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
mesh_terms: D004866:Equipment Contamination; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D016485:Needle Sharing / Q000009:adverse effects*; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*