title: HIV, Hepatitis B and C among people who inject drugs: high prevalence of HIV and Hepatitis C RNA positive infections observed in Delhi, India.
abstract: BACKGROUND
  India has large PWID (persons who inject drugs) population estimated at 177,000. PWIDs are at high risk for HIV, Hepatitis B (HBV) and Hepatitis C (HCV) infections. We report the prevalence of HIV, HBV and HCV infections and correlates of HIV-HCV co-infection among male PWIDs in Delhi.
  
  
  METHODS
  3748 male PWIDs were recruited for a longitudinal HIV incidence study. Participants were tested for HBV and HCV infections at their first follow-up visit (FV1) using serum HBV-surface antigen, and HCV-antibody tests followed by HCV RNA PCR, respectively. All PWIDs who were HIV-negative at enrollment, were re-tested for HIV at FV1. Multinomial logistic regression was employed to identify predictors of HIV, HCV and HIV-HCV co-infection.
  
  
  RESULTS
  Overall prevalence of HIV, HBV and HCV among 2,292 participants tested at FV1 was 25.9%, 9.7% and 53.7%, respectively. 6.4% of the participants had HIV mono-infection, 34.1% had HCV mono-infection, and 19.6% had HIV-HCV co-infection. 26% of HIV-positive participants without HCV were HBsAg positive. In the regression model, having practiced at least one risky injection in the past month (relative risk ratio (RRR): 1.38; 95% CI: 1.01-1.89) and not knowing his own HIV status (RRR: 1.65, 95% CI: 1.25-2.17) were independent predictors for HIV-HCV co-infection. Longer duration of drug injections was associated with a higher likelihood of HCV mono-infection (2-5 years RRR: 2.13; 6-10 years RRR: 2.74; ≥11 years RRR: 3.14) and HIV-HCV co-infection (2-5 years RRR: 5.14; 6-10 years RRR: 8.53; >11 years RRR: 8.03). Higher frequency of injection days/month was associated with a higher likelihood of HCV mono-infection (≤10 days/month RRR: 1.61; 11-20 days/month RRR: 3.15; 21-30 days/month RRR: 3.47) and HIV-HCV co-infections (≤10 days/month RRR: 2.26; 11-20 days/month RRR: 3.46; 21-30 days/month RRR: 4.83).
  
  
  CONCLUSIONS
  We report a high prevalence of HIV, HCV and HIV-HCV co-infection among male PWIDs in Delhi. A tenth of the participants were HBsAg positive. Targeted Intervention programs should make HBV/HCV testing, prevention and care more accessible for PWIDs.
authors.affiliation: Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003, India. lsaraswati@popcouncil.org.
authors.forename: Lopamudra
authors.initials: L
authors.lastname: Ray Saraswati
authors.affiliation: Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003, India. asarna@popcouncil.org.
authors.forename: Avina
authors.initials: A
authors.lastname: Sarna
authors.affiliation: Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003, India. mphsebastian@gmail.com.
authors.forename: Mary Philip
authors.initials: MP
authors.lastname: Sebastian
authors.affiliation: Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003, India. vs.vartikas@gmail.com.
authors.forename: Vartika
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Sahara Center for Residential Care and Rehabilitation, New Delhi, India. iramadan@gmail.com.
authors.forename: Ira
authors.initials: I
authors.lastname: Madan
authors.affiliation: ARISE Project, PATH, Washington, DC, USA. ithior@path.org.
authors.forename: Ibou
authors.initials: I
authors.lastname: Thior
authors.affiliation: ARISE Project, PATH, Washington, DC, USA. jpulerwitz@popcouncil.org.|Population Council, Washington, DC, USA. jpulerwitz@popcouncil.org.
authors.forename: Julie
authors.initials: J
authors.lastname: Pulerwitz
authors.affiliation: Population Council, Washington, DC, USA. wtun@popcouncil.org.
authors.forename: Waimar
authors.initials: W
authors.lastname: Tun
mesh_terms: D000328:Adult; D060085:Coinfection / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006509:Hepatitis B / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012367:RNA, Viral; D012044:Regression Analysis; D012698:Serologic Tests; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral