Hepatitis C Virus Infection Among Needle Sharing Drug Users

hepatitis c infections among drug users in south florida

 

Prevalence, Efficacy of Preventative Measures and Treatment

What is a hepatitis C virus infection, why is it important and what is the risk of being infected? Hepatitis C virus is a virus that infects the liver and in up to 80% of those infected it results in a chronic carrier state. The high incidence of chronic carrier state is important because of the high infective capacity of the virus. Of those 80% that enter the chronic carrier state up to 25% can have progression of disease to cirrhosis, liver failure or hepatocellular carcinoma.

Why is the infective capacity of the hepatitis C virus so high?

  • High incidence of chronic carrier state after infection means that the virus remains active and able to infect in the MAJORITY of those who contract it. So potentially, one person that contracts the hepatitis C virus can spread the infection to as many people as they share fluids or blood with.
  • The hepatitis C virus can remain viable and infective in liquids, syringes and on objects for many weeks. This is important when one considers the fact that many PWID share either syringes or drug preparations equipment. Even if they use the equipment weeks after the infected person has used it without disinfecting it they can become infected with the virus. For this reason, PWID that share equipment are at a higher risk of becoming infected – there is a higher number of female injectors who share equipment than males, making females more susceptible. The highest number of newly infected individuals are those that are new to injection drug use, especially in the first two years of use. This is supposedly because they are seronegative prior to drug use and due to the high infectivity and sharing of equipment they quickly contract the virus.

 

Why is education about the infectivity of hepatitis C virus important?

  • Hepatitis C virus is 10 to 15 times more infective than HIV and its prevalence is rapidly increasing in PWID. The age group that seems to be most effected by this statistic is the young, below the age of 30, adult. In the United States it is suspected that mortality from hepatitis C virus will exceed that of HIV.
  • When we consider these newly emerging statistics, we can see the importance of educating young adults on preventative strategies to slow down this epidemic spread in the United States as well as globally.

 

How can the spread of hepatitis C virus be prevented?

Preventative considerations for hepatitis C virus can be approached from two angles: individual prevention and group prevention. Whichever approach is taken, one thing from recently emerging studies is clear: prevention is a lot more effective if multiple prevention strategies are taken rather than a single prevention strategy.

Some studies that have demonstrated positive results are those that combine multiple therapies rather than using a single therapy. Some examples that have been studied are combinations of opiate replacement therapy and syringe access programs as well as those combining opiate replacement therapy with hepatitis C virus infection prevention programs.

Strategies used for hepatitis C virus prevention are:

  • Screening for hepatitis C virus
  • Counseling
  • Increasing the number of syringe access programs to reduce sharing of needles and syringes
  • Reduced sharing of drug preparation equipment
  • Treatment with opiate replacement therapy

However, as noted earlier these interventions are less effective on their own than they are when combined. Some studies indicate almost a 75% reduction in incidence when multiple preventative modalities are combined.

What are the treatment options for hepatitis C virus positive individuals?

  • Interferon-alpha is used for the treatment of hepatitis C virus. Interferon-alpha behaves like a substance produced by the immune system that prevents the replication of virally infected cells as well as encouraging white blood cells to “kill” these cells. It is usually given as an injection under the skin. Some side effects are pain, itchiness or redness at the injection site as well as loss of appetite and flu-like symptoms.
  • Ribavirin is an antiviral therapy that may or may not be used in combination with interferon-alpha for the treatment of hepatitis C virus, it is usually ingested orally as a capsule or tablet. Due to this drugs high teratogenic effect, it should be used in combination with two methods of birth control by women who either take the drug or have partners that are taking the drug.

Hepatitis C virus is a highly infective virus that is increasing in prevalence in the under 30, injection drug user population. Due to its highly infective nature, the debilitating course of the disease, the high intensity of the treatment and the presence of proven preventative methods the focus in populations susceptible to hepatitis C virus should be on the prevention of the disease.