Abstract
BackgroundIndia 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.Methods3748 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.ResultsOverall 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).ConclusionsWe 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.
Highlights
India has large People Who Inject Drugs (PWID) population estimated at 177,000
Participants who had not undertaken Human Immunodeficiency Virus (HIV) testing or did not know of their HIV-status prior to the study were at higher risk of HIV mono-infection (RRR: 1.92) and HIV-Hepatitis C (HCV) co-infection (RRR: 1.65)
Longer duration of drug injections was associated with a higher likelihood of HCV mono-infection with a dose response effect (2–5 years Relative risk ratio (RRR): 2.13; 6–10 years RRR: 2.74; >11 years RRR: 3.14 years) and HIV-HCV co-infection (2–5 years RRR: 5.14; 6–10 years RRR: 8.53; >11 years RRR: 8.03)
Summary
India has large PWID (persons who inject drugs) population estimated at 177,000. We report the prevalence of HIV, HBV and HCV infections and correlates of HIV-HCV co-infection among male PWIDs in Delhi. People who inject drugs (PWIDs) are at high risk for blood-borne infections that include HIV, hepatitis B (HBV) and C virus (HCV). The PWID population has been largely studied in the high HIV prevalence states in north-eastern and southern parts of the country, where HIV (25.4 -59.6 %), HBV (10 %) and HCV (54.5-90.4 %) prevalence has been reported [9, 13,14,15]. There is emerging evidence of PWID presence in low HIV prevalence states of the country (the north-western part), only a few studies have documented HIV (29-37 %), HBV (40 %) and HCV (36-49 %) prevalence in these states [16,17,18]. Further we characterize the correlates of HIV and Hepatitis C co-infection in this population
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