title: High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India.
abstract: OBJECTIVE
  It is well documented that the Northeast state of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection.
  
  
  METHODS
  Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection.
  
  
  RESULTS
  HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection.
  
  
  CONCLUSIONS
  The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Victoria, Australia.
authors.forename: Amenla
authors.initials: A
authors.lastname: Nuken
authors.affiliation: Regional Medical Research Centre (ICMR), Dibrugarh, India.
authors.forename: Gajendra Kumar
authors.initials: GK
authors.lastname: Medhi
authors.affiliation: Community Medicine Department, Regional Institute of Medical Sciences, Imphal, Manipur, India.
authors.forename: Brogen Singh
authors.initials: BS
authors.lastname: Akoijam
authors.affiliation: Khwai Brahamapur Nagamapal, Imphal, Manipur, India.
authors.forename: H Umesh
authors.initials: HU
authors.lastname: Sharma
authors.affiliation: Regional Medical Research Centre (ICMR), Dibrugarh, India.
authors.forename: Jagadish
authors.initials: J
authors.lastname: Mahanta
mesh_terms: D000293:Adolescent; D000328:Adult; D060085:Coinfection / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D016174:Hepacivirus / Q000302:isolation & purification* / Q000472:pathogenicity; D006526:Hepatitis C / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012725:Sexual Behavior