title: Higher incidence of HCV in females compared to males who inject drugs: A systematic review and meta-analysis.
abstract: Women who inject drugs have been shown to have higher incidence of HIV and risk behaviours than men, but there are conflicting reports about hepatitis C virus (HCV) incidence. We systematically reviewed the literature to examine the female-to-male (F:M) HCV incidence in female and male persons who inject drugs (PWID), and also to explore the heterogeneity (i.e. methodological diversity) in these differences. We searched PubMed and EMBASE for studies published between 1989 and March 2015 for research that reported incidence of HCV infection by sex or HCV incidence F:M rate ratio. A total of 28 studies, which enrolled 9325 PWID, were included. The overall pooled HCV incidence rate (per 100 person-years observation) was 20.36 (95% CI: 13.86, 29.90) and 15.20 (95% CI: 10.52, 21.97) in females and males, respectively. F:M ratio was 1.36:1 (95% CI: 1.13, 1.64) with substantial heterogeneity (I-squared=71.6%). The F:M ratio varied by geographic location from 4.0 (95% CI: 1.80, 8.89) in China to 1.17 (95% CI: 0.95, 1.43) in the U.S. In studies which recruited participants from community settings, the F:M ratio was 1.24 (95% CI: 1.03, 1.48), which was lower than that reported in the clinical settings (1.72, 95% CI: 0.86, 3.45). The number of studies included provided sufficient statistical power to detect sex differences in this analysis. Our findings raise questions and concerns regarding sex differences with respect to the risk of HCV. Both behavioural and biological studies are needed to investigate causes and potential mechanisms as well as sex-specific prevention approaches to HCV infection.
authors: The Clinical Research Education Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: A
authors: A
authors: Esmaeili
authors: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors: A
authors: A
authors: Mirzazadeh
authors: Foundation for Integrative AIDS Research, Brooklyn, NY, USA.
authors: G M
authors: GM
authors: Carter
authors: Department of Pathology and Laboratory Medicine, Clinical Cytogenetics, UCLA, Los Angeles, CA, USA.
authors: A
authors: A
authors: Esmaeili
authors: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors: B
authors: B
authors: Hajarizadeh
authors: Thomas C. Chalmers Clinical Trials Unit, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: H S
authors: HS
authors: Sacks
authors: Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors: K A
authors: KA
authors: Page
mesh_terms: D055030:Drug Users; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*
keywords: females; hepatitis C; incidence; meta-analysis; sex differences; systematic review