HCV and HIV infection among heroin addicts in methadone maintenance treatment (MMT) and not in MMT in Changsha and Wuhan, China.

Xuyi Wang,Dongyi Zhou,Tieqiao Liu,Yi Li,Wei Hao,Linxiang Tan,Yao Zhang

doi:10.1371/journal.pone.0045632

Abstract

ObjectiveTo compare HCV and HIV infection among heroin addicts in MMT and not in MMT in two large cities in central China.MethodsA total of 541 heroin addicts were recruited from MMT clinics and voluntary detoxification centers in Changsha and Wuhan, China. Structured questionnaires collected data on their socio-demographics, clinical status, risk behaviors, and their knowledge of HIV. Their HIV serostatus and Hepatitis C virus (HCV) serostatus were determined by testing antibodies in blood serum.ResultsWe observed a higher prevalence of HCV infection among MMT heroin addicts (82.3%) than that in the non-MMT group (50.6%). However, our findings indicated that the heroin addicts in MMT had less drug or sexual HIV/HCV risk behaviors and more knowledge about HIV than non-MMT addicts. The heroin addicts in MMT had a significantly higher percentage of individuals who always used condoms (44.9%) compared with patients in the non-MMT group (14.6%, p = 0.039), and they had more knowledge about HIV than non-MMT individuals (p<.001). The percentage of HIV-positive addicts in the MMT group (0.7%) and non-MMT group (0.8%) were almost same.ConclusionOur study indicated that the rate of HCV infection among heroin addicts among MMT or non-MMT settings in central China is very high. The non-MMT heroin addicts have higher risk of becoming infected with HCV in the future, while at present they have lower rates of HCV infection than MMT heroin addicts. Although rates of HIV infection among MMT and non-MMT heroin addicts are low now, they are all at great risk of becoming infected with HIV in the future, especially for non-MMT heroin addicts. We should use the MMT sites as a platform to improve the control of HCV and HIV infection in heroin addicts.

Highlights

Infection with Hepatitis C virus (HCV), which can develop into liver cirrhosis, liver failure, and hepatocellular carcinoma, causes heavy disease burden in the world [1]
72.8% of the subjects tested positive for HCV, and there was a significant difference between the Maintenance Treatment (MMT) and nonMMT groups: 83.2% of MMT addicts were HCV positive and 50.6% of non-MMT addicts were HCV positive
The heroin-dependent patients in the MMT group reported a significantly higher proportion of always using condoms (44.9%) than patients in the non-MMT group(14.6%, p = 0.039).Comparing the sharing of syringes in the past year and not using condoms, the heroin-dependent patients in the non-MMT group reported a higher proportion than patients in MMT, not at a statistically significant

Summary

Introduction

Infection with HCV, which can develop into liver cirrhosis, liver failure, and hepatocellular carcinoma, causes heavy disease burden in the world [1]. Unlike in North America and Europe, the HCV pandemic has not been systematically studied and characterized in China. The predominant sources of HCV infection in China are believed to be unsafe iatrogenic transmission and injection drug use [3].Like all the blood-borne viruses, HCV infections are efficiently transmitted through unsafe drug injection, and even more efficiently spread by this practice than is human immunodeficiency virus (HIV) [1,4]. Illicit opiate use is considered to be a major social and public health problem in both western and eastern countries. Beginning in the 1990s, China experienced a rapid increase in illicit drug use: the number of registered addicts in 2005 was 1.16million [5,6], while the actual number of drug addicts was estimated to have reached 3.5 million. At least 75–85% of registered drug addicts used heroin and 50–70% of heroin users were injection drug users (IDUs) [5,6]

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Discussion

Conclusion