Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000 to 2017: Protective effects of non-injecting drug use

Drug and Alcohol Dependence

Available online 12 September 2018

Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000 to 2017: Protective effects of non-injecting drug use

Don C. Des Jarlais, K. Arasteh, J. Feelemyer, C. McKnight, David M. Barnes, David C. Perlman, A. Uuskula, H.L.F. Cooper, Susan Tross
DOI: https://doi.org/10.1016/j.drugalcdep.2018.07.034
Publication stage: In Press Accepted Manuscript

Published online: September 12, 2018

Full-Text HTML

PDF

Highlights
•Reverse transitioning was strongly associated with lower HCV seroprevalence.
•HCV seropositivity was inversely associated with current non-injecting heroin use.
•Injecting cocaine was associated with behavior likely to transmit HCV.
•NYC has high rates of HCV infection among persons who began injecting since 2000.

Abstract
Objective
Assess hepatitis C virus (HCV) prevalence and incidence among person who began injecting drugs during the opioid epidemic in New York City (NYC) and identify possible new directions for reducing HCV infection among persons who inject drugs.

Methods
846 persons who began injecting drugs between 2000 and 2017 were recruited from persons entering Mount Sinai Beth Israel substance use treatment programs. A structured interview was administered and HCV antibody testing conducted. Protective effects of non-injecting drug use were examined among persons who “reversed transitioned” to non-injecting drug use and persons who used non-injected heroin in addition to injecting.

Results
Participants were 79% male, 41% White, 15% African-American, 40% Latinx, with a mean age of 35. Of those who began injecting in 2000 or later, 97 persons (11%) “reverse transitioned” back to non-injecting drug use. Reverse transitioning was strongly associated with lower HCV seroprevalence (30% versus 47% among those who continued injecting, p < 0.005). Among those who continued injecting, HCV seropositivity was inversely associated with current non-injecting heroin use (AOR = 0.72, 95%CI 0.52-0.99). HCV incidence among persons continuing to inject was estimated as 13/100 person-years. HCV seropositive persons currently injecting cocaine were particularly likely to report behavior likely to transmit HCV.

Conclusions
Similar to other locations in the US, NYC is experiencing high rates of HCV infection among persons who have begun injecting since 2000. New interventions that facilitate substitution of non-injecting for injecting drug use and that reduce transmission behavior among HCV seropositives may provide additional methods for reducing HCV transmission.