Abstract
The aim of this study was to gain insight in transmission routes of hepatitis C virus (HCV) infection among never-injecting drug users (DU) by studying, incidence, prevalence, determinants and molecular epidemiology of HCV infection. From the Amsterdam Cohort Studies among DU, 352 never-injecting DU were longitudinally tested for HCV antibodies. Logistic regression was used to identify factors associated with antibody prevalence. Part of HCV NS5B was sequenced to determine HCV genotype and for phylogenetic analyses, in which sequences were compared with those from injecting DU. HCV antibody prevalence was 6.3% and HCV incidence was 0.49/1000 PY. HIV-positive status, female sex and starting injection drug use during follow-up (a putative marker of past injection drug use), were independently associated with HCV prevalence. The main genotypes found were genotype 3a (50%) and 1a (30%). Phylogenetic analysis revealed that HCV strains in never-injecting DU did not cluster together and did not differ from HCV strains circulating in injecting DU. We found a higher HCV prevalence in never-injecting DU than in the general population. Phylogenetic analysis shows a strong link with the injecting DU population. The increased risk could be related to underreporting of injecting drug use or to household or sexual transmission from injectors to noninjectors. Our findings stress the need for HCV testing of DU who report never injecting, especially given the potential to treat HCV infection effectively.
Highlights
Acute hepatitis C virus (HCV) infection is usually asymptomatic, and leads to chronic infection in 50–80% of patients [1]
Individuals who were HCV-negative at Amsterdam Cohort Study (ACS) entry were tested for HCV antibodies at their last ACS visit before November 2005
Among the 1276 drug users (DU) who participated in the ACS and had two or more visits between December 1985 and November 2005, 364 DU reported never having injected drugs before study entry
Summary
Acute hepatitis C virus (HCV) infection is usually asymptomatic, and leads to chronic infection in 50–80% of patients [1]. Decades of chronic HCV infection can lead to liver cirrhosis and, in 1–5% of these patients, eventually to hepatocellular carcinoma as well [2]. It was designed to evaluate the sexual and blood borne transmission of HIV, other blood borne pathogens, and sexually transmitted diseases, as well as the determinants of transition to injecting drug use. This design has the potential to determine
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