Decline in incidence of HIV and hepatitis C virus infection among injecting drug users in Amsterdam; evidence for harm reduction?
OBJECTIVE
In Amsterdam, HIV prevalence has nearly halved among injecting drug users (IDU) since 1990. Hepatitis C virus (HCV) prevalence also declined; HIV and HCV incidence dropped to nearly zero. We examined possible explanations for these time trends, among which the implementation of harm reduction measures aimed at reducing the risk behaviour of IDU.


METHODS
We used individual-based modelling of the spread of HIV and HCV. Information about demographic parameters was obtained from the Amsterdam Cohort Study (ACS) among drug users. The model included changes in inflow of new IDU and death rates over time, the latter dependent on age and time since HIV seroconversion. We considered different scenarios of risk behaviour.


METHODS
IDU in Amsterdam.


METHODS
Simulated HIV and HCV incidence and prevalence were compared with ACS data.


RESULTS
Assuming that harm reduction measures had led to a strong decrease in risk behaviour over time improved the model fit (squared residuals decreased by 30%). However, substantial incidence and HIV prevalence decline were already reproduced by incorporating demographic changes into the model. In particular, lowered disease spread might be a result of depletion of high-risk IDU among those at risk for disease, and a decrease in the number of high-risk individuals in the population due to HIV-related mortality.


CONCLUSIONS
Marked decreases in HIV and HCV in Amsterdam since 1990 could be due partly to harm reduction measures; however, they may also be attributable largely to changes in the IDU population. Future research aimed at quantifying the benefits of interventions should not neglect the impact of natural epidemic progression and demographic changes.
Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands. A.S.deVos-4@umcutrecht.nl
Anneke S
AS
de Vos
Jannie J
JJ
van der Helm
Amy
A
Matser
Maria
M
Prins
Mirjam E E
ME
Kretzschmar
D000328:Adult; D015331:Cohort Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D040261:Harm Reduction; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult