Options for reducing HIV transmission related to the dead space in needles and syringes

William A Zule,Samuel R Friedman,Georgiy V Bobashev,Poonam G Pande,V Anna Gyarmathy,David Otiashvili,Don C Des Jarlais

doi:10.1186/s12954-017-0207-5

Abstract

BackgroundWhen shared by people who inject drugs, needles and syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently.MethodsWe measured dead space in 56 needle and syringe combinations obtained from needle and syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing.ResultsSyringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space syringes with permanently attached needles, 13 μL in high dead space syringes with low dead space needles, 45 μL in low dead space syringes with high dead space needles, and 99 μL in high dead space syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space syringes with permanently attached needles and highest for low dead space syringes with high dead space needles.ConclusionThe dead space in different low dead space needle and syringe combinations varied substantially. To reduce HIV transmission related to syringe sharing, needle and syringe programs need to combine this knowledge with the needs of their clients.

Highlights

When shared by people who inject drugs, needles and syringes with different dead space may affect the probability of Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission differently
Dead space measurements We measured the dead space in 56 different needle and syringe combinations that we obtained from Needle and syringe program (NSP) and in two other low dead space (LDS) syringe designs—one that a researcher sent us and one that we purchased from the manufacturer
The mean dead space ranged from 3.0 μL in LDS syringes with permanently attached needles to 98.9 μL in high dead space (HDS) syringes with HDS needles (Table 1)

Summary

Introduction

When shared by people who inject drugs, needles and syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently. In 2012, the WHO recommended that NSPs offer their clients low dead space (LDS) syringes [5, 7], which may reduce the survival of HIV and HCV [8, 9] as well as reduce transmission risk [10,11,12]. This recommendation was based on LDS syringes with permanently attached needles

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Discussion

Conclusion