The HCV Synthesis Project: Scope, methodology, and preliminary results

Rebecca K Stern,Don Des Jarlais,Don Des Jarlais,Peter Flom,Roberta Scheinmann,Enrique R Pouget,Shiela Strauss,Corina Lelutiu-Weinberger,Holly Hagan

doi:10.1186/1471-2288-8-62

Abstract

BackgroundThe hepatitis C virus (HCV) is hyper-endemic in injecting drug users. There is also excess HCV among non-injection drug users who smoke, snort, or sniff heroin, cocaine, crack, or methamphetamine.MethodsTo summarize the research literature on HCV in drug users and identify gaps in knowledge, we conducted a synthesis of the relevant research carried out between 1989 and 2006. Using rigorous search methods, we identified and extracted data from published and unpublished reports of HCV among drug users. We designed a quality assurance system to ensure accuracy and consistency in all phases of the project. We also created a set of items to assess study design quality in each of the reports we included.ResultsWe identified 629 reports containing HCV prevalence rates, incidence rates and/or genotype distribution among injecting or non-injecting drug user populations published between January 1989 and December 2006. The majority of reports were from Western Europe (41%), North America (26%), Asia (11%) and Australia/New Zealand (10%). We also identified reports from Eastern Europe, South America, the Middle East, and the Caribbean. The number of publications reporting HCV rates in drug users increased dramatically between 1989 and 2006 to 27–52 reports per year after 1998.ConclusionThe data collection and quality assurance phases of the HCV Synthesis Project have been completed. Recommendations for future research on HCV in drug users have come out of our data collection phase. Future research reports can enhance their contributions to our understanding of HCV etiology by clearly defining their drug user participants with respect to type of drug and route of administration. Further, the use of standard reporting methods for risk factors would enable data to be combined across a larger set of studies; this is especially important for HCV seroconversion studies which suffer from small sample sizes and low power to examine risk factors.

Highlights

The hepatitis C virus (HCV) is hyper-endemic in injecting drug users
Hepatitis C virus infection is hyper-endemic among injection drug user (IDU) populations [1,2], and evidence suggests that excess HCV infection occurs in non-injection drug users (NIDUs) who administer heroin, cocaine, or amphetamine by other routes, such as inhalation or smoking [3,4]
The main reasons for disqualification were 1) no HCV prevalence or incidence data (n = 71); 2) drug user prevalence data aggregated, i.e., IDU and NIDU estimates were not disaggregated or distinguished from non-drug users (n = 64); 3) sample selection based on HCV status (n = 56); 4) results based on HCV-RNA testing alone (n = 9); and 5) self-reported HCV status was basis for prevalence estimates and no lab testing was performed (n = 26)

Summary

Introduction

The hepatitis C virus (HCV) is hyper-endemic in injecting drug users. Hepatitis C virus infection is hyper-endemic among injection drug user (IDU) populations [1,2], and evidence suggests that excess HCV infection occurs in non-injection drug users (NIDUs) who administer heroin, cocaine, or amphetamine by other routes, such as inhalation or smoking [3,4]. Anti-HCV prevalence varied substantially, between 30 and 90% Some of this variation was clearly related to time at risk, with a fairly consistent and relatively linear relationship between number of years injecting and increasing antiHCV prevalence [11]. Research suggested that HCV infection varied in IDU populations in relation to characteristics of person, place and time, and that insights into HCV prevention might be obtained via a systematic, quantitative review of available studies

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Conclusion