title: High hepatitis C virus prevalence and incidence in a community cohort of young heroin injectors in a context of extensive harm reduction programmes.
abstract: BACKGROUND
  Cohort studies on hepatitis C virus (HCV) among drug injectors are scarcer than studies on HIV. Combined harm reduction interventions (HRIs) can prevent HCV infection. Spain has a medium-high coverage of HRIs.
  
  
  METHODS
  513 young heroin users who injected drugs in the past 12 months (recent injectors) were street-recruited in 2001-2003 and followed until 2006 in three Spanish cities; 137 were anti-HCV seronegative, 77 of whom had ≥1 follow-up visit. Dried blood spots were tested for anti-HCV. HCV incidence and predictors of infection were estimated using Poisson models.
  
  
  RESULTS
  At baseline, 73% were anti-HCV positive. Overall incidence (n=77) of HCV seroconversion was 39.8/100 person-years (py) (95% CI 28.7 to 53.8). Excluding non-injectors during follow-up from the analysis (n=57), HCV incidence was 52.9/100 py (95% CI 37.4 to 72.5). Injecting at least weekly (incidence rate ratio (IRR)=5.2 (95% CI 2.5 to 11.1)) and having ≥2 sexual partners (IRR=2.2 (95% CI 1.1 to 4.7)) were independent predictors of HCV seroconversion; drug-injection history <2 years was marginally associated (IRR=2.4 (95% CI 0.9 to 4.7)). HCV incidence may have been underestimated due to differential attrition.
  
  
  CONCLUSIONS
  Despite fairly high HRI coverage among Spanish drug injectors, a distressingly high incidence of HCV in a context of high HCV prevalence was found among young heroin injectors.
authors: National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain.
authors: Fernando
authors: F
authors: Vallejo
authors: National School of Public Health, Carlos III Health Institute, Madrid, Spain.
authors: Gregorio
authors: G
authors: Barrio
authors: Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain Public Health Agency, Barcelona, Spain Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.
authors: M Teresa
authors: MT
authors: Brugal
authors: National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain.
authors: Jose
authors: J
authors: Pulido
authors: Service of Microbiology, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain.
authors: Carlos
authors: C
authors: Toro
authors: National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain.
authors: Luis
authors: L
authors: Sordo
authors: Public Health Agency, Barcelona, Spain Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Spain.
authors: Albert
authors: A
authors: Espelt
authors: National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain.
authors: María J
authors: MJ
authors: Bravo
mesh_terms: D000328:Adult; D015897:Comorbidity; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D040261:Harm Reduction; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006556:Heroin Dependence / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D015994:Incidence; D008297:Male; D018671:Needle-Exchange Programs; D058850:Opiate Substitution Treatment; D015995:Prevalence; D000069078:Seroconversion; D012725:Sexual Behavior; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D055815:Young Adult
keywords: EPIDEMIOLOGY; HEPATITIS; SUBSTANCE ABUSE