Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000-2017: Protective effects of non-injecting drug use

• Type of Material: Article
• Authors: Don C. Des Jarlais, Icahn School of Medicine at Mount Sinai; Kamyar Arasteh, Icahn School of Medicine at Mount Sinai; Jonathan Feelemyer, Icahn School of Medicine at Mount Sinai; Courtney McKnight, Icahn School of Medicine at Mount Sinai; David M. Barnes, Icahn School of Medicine at Mount Sinai; David C. Perlman, Icahn School of Medicine at Mount Sinai; Anneli Uuskula, University of Tartu; Hannah Cooper, Emory University; Susan Tross, Columbia University
• Language: English
• Date: 2018-11-01
• Publisher: Elsevier Ireland LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.drugalcdep.2018.07.034
• Title of Journal or Parent Work: Drug and Alcohol Dependence
• Volume: 192
• Start Page: 74
• End Page: 79
• Grant/Funding Information: This work was supported through grants R01DA003574 and 5-DP1-DA039542 from the US National Institute on Drug Abuse The funding agency had no role in the design, conduct, data analysis or report preparation for the study
• Keywords: Opioid epidemic; HIV-INFECTION; Substance Abuse; HIV; RISK; Hepatitis C; Persons who inject drugs; Science & Technology; Life Sciences & Biomedicine; Psychiatry
• Research Categories: Sociology, Public and Social Welfare; Health Sciences, Public Health

Abstract

Objective: Assess hepatitis C virus (HCV) prevalence and incidence among person who began injecting drugs during the opioid epidemic in New York City (NYC) and identify possible new directions for reducing HCV infection among persons who inject drugs. Methods: 846 persons who began injecting drugs between 2000 and 2017 were recruited from persons entering Mount Sinai Beth Israel substance use treatment programs. A structured interview was administered and HCV antibody testing conducted. Protective effects of non-injecting drug use were examined among persons who “reversed transitioned” to non-injecting drug use and persons who used non-injected heroin in addition to injecting. Results: Participants were 79% male, 41% White, 15% African-American, 40% Latinx, with a mean age of 35. Of those who began injecting in 2000 or later, 97 persons (11%) “reverse transitioned” back to non-injecting drug use. Reverse transitioning was strongly associated with lower HCV seroprevalence (30% versus 47% among those who continued injecting, p < 0.005). Among those who continued injecting, HCV seropositivity was inversely associated with current non-injecting heroin use (AOR = 0.72, 95%CI 0.52-0.99). HCV incidence among persons continuing to inject was estimated as 13/100 person-years. HCV seropositive persons currently injecting cocaine were particularly likely to report behavior likely to transmit HCV. Conclusions: Similar to other locations in the US, NYC is experiencing high rates of HCV infection among persons who have begun injecting since 2000. New interventions that facilitate substitution of non-injecting for injecting drug use and that reduce transmission behavior among HCV seropositives may provide additional methods for reducing HCV transmission.