Abstract
Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.
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References
Roy K, Hay G, Andragetti R, Taylor A, Goldberg D, Wiessing L. Monitoring hepatitis C virus infection among injecting drug users in the European Union: a review of the literature. Epidemiol Infect. 2002;129(3):577–585.
Abdala N, Carney J, Durante A, et al. Estimating the prevalence of syringe-borne and sexually transmitted diseases among injection drug users in St Petersburg, Russia. Int J STD AIDS. 2003;14(10):697–703.
Alter M. Hepatitis C virus infection in the United States. J Hepatol. 1999;31(Suppl 1):88–91.
Garten R, Lai S, Zhang J, et al. Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China. Int J Epidemiol. 2004;33(1):182–188.
Trepo C, Pradat P. Hepatitis C virus infection in Western Europe. J Hepatol. 1999; 31(Suppl 1):80–83.
Weissenbacher M, D R, Radulich G, et al. High seroprevalence of bloodborne viruses among street-recruited injection drug users from Buenos Aires, Argentina. Clin Infect Dis. 2003;15(37 Suppl 5):S348–352.
Alter M, Moyer L. The importance of preventing hepatitis C virus infection among injection drug users in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(Suppl 1):S6–10.
Diaz T, Buehler J, Castro K, Ward J. AIDS trends among Hispanics in the United States. Am J Public Health. 1993;83(4):504–509.
Selik R, Castro K, Pappaioanou M. Racial/ethnic differences in the risk of AIDS in the United States. Am J Public Health. Dec 1988;78(12):1539–1545.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report. 2003;13(2).
Deren S, Robles R, Andia J, Colon H, Kang S, Perlis T. Trends in HIV seroprevalence and needle sharing among Puerto Rican drug injectors in Puerto Rico and New York. J Acquir Immune Defic Syndr Hum Retrovirol. 1 Feb 2001;26(2):164–169.
Deren S, Kang S, Colon H, Andia J, Robles R. HIV incidence among high-risk Puerto Rican drug users: a comparison of East Harlem, New York, and Bayamón, Puerto Rico. J Acquir Immune Defic Syndr. 15 Aug 2004;36(5):1067–1074.
Colon H, Robles R, Deren S, et al. Between-city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamón, Puerto Rico. J Acquir Immune Defic Syndr Hum Retrovirol. 2001;27(4):405–413.
Finlinson H, Colon H, Lopez M, Robles R, Cant J. Injecting shared drugs: an observational study of the process of drug acquisition, preparation, and injection by Puerto Rican drug users. J Psychoactive Drugs. 2005;37:37–49.
Montoya I, Bell D, Richard A, Carlson J, Trevino R. Estimated HIV risk among Hispanics in a national sample of drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;21(1):42–50.
Cagle H, Fisher D, Senter T, Thurmond R, AJ K. Classifying skin lesions of injection drug users: a method for corroborating disease risk. DHHS Pub. No. (SMA) 03-3771. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. 2002.
Robles R, Colón H, Freeman D. Copping areas as sampling and recruitment sites for out-of-treatment crack and injection drug users. Drugs and Society. 1993;7:91–105.
Fisher D, Needle R, Weatherby N, Brown B, Booth R, Williams M. Reliability of drug user self report. In: Abstract Book, IX International Conference on AIDS, June 6–11, 1993; Berlin, Germany, Abstract no. PO-C35-3355.
Needle R, Weatherby N, Chitwood D, et al. Reliability of self-reported HIV risk behaviors of drug users. Psychol Addictive Behaviors. 1995;9:242–250.
Robles R, Colón H, Sahai H, Matos T, Marrero C, Reyes J. Behavioral risk factors and human immunodeficiency virus (HIV) prevalence among intravenous drug users in Puerto Rico. Am J Epidemiol. 1992;135:531–540.
Habib S, Lovejoy F, Aspin C. Hepatitis C prevalence and risk behavior of injecting drug users in Sydney: a continuing concern. Southeast Asian J Trop Med Public Health. 2001;32(4):823–834.
Oliveira M, Bastos F, Telles P, et al. Prevalence and risk factors for HBV, HCV and HDV infections among injecting drug users from Rio de Janeiro, Brazil. Braz J Med Biol Res. 1999;32(9):1107–1114.
Quaglio G, Lugoboni F, Pajusco B, et al. Hepatitis C virus infection: prevalence, predictor variables and prevention opportunities among drug users in Italy. J Viral Hepatitis. 2003;10(5):394–400.
Diaz T, Des Jarlais D, Vlahov D, et al. Factors associated with prevalent hepatitis C: differences among young adult injection drug users in lower and upper Manhattan, New York City. Am J Public Health. 2001;91(1):23–30.
Garfein R, Vlahov D, Galai N, Doherty M, Nelson KE. Viral infections in short-term injection drug users: the prevalence of hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health 1996;86:655–661.
Hahn J, Page-Shafer K, Lum P, Ochoa K, Moss AR. Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco. Hepatology. 2001;34(1):180–187.
Thorpe L, Ouellet L, Hershow R, et al. Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment. Am J Epidemiol. 2002; 155(7):645–653.
Reyes J, Robles R, Colón H, Freeman D, Sahai H, Matos TD. Risk factors for shooting gallery use among drug injectors in Puerto Rico. Puerto Rico Health Sci J. 1996;15:227–231.
Robles R, Marrero C, Reyes J, et al. Risk behaviors, HIV seropositivity and TB infection among IDUs who operate shooting galleries in Puerto Rico. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17:477–483.
Battjes R, Pickens R, Haverkos H, Sloboda Z. HIV risk factors among injecting drug users in five U.S. cities. AIDS. May 1994;8(5):681–687.
Hien N, Giang L, Binh P, Wolffers I. The social context of HIV risk behaviour by drug injectors in Ho Chi Minh City, Vietnam. AIDS Care. Aug 2000;12(4):483–495.
Strathdee S, Galai N, Safaiean M, et al. Sex differences in risk factors for HIV seroconversion among injection drug users: a 10-year perspective. Arch Intern Med. 28 May 2001;161(10):1281–1288.
Thorpe L, Ouellet L, Levy J, Williams I, Monterroso ER. Hepatitis C virus infection: prevalence, risk factors, and prevention opportunities among young injection drug users in Chicago, 1997–1999. J Infect Dis. 2000; 182(6):1588–1594.
Villano S, Vlahov D, Nelson K, Lyles C, Cohn S, Thomas DL. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland. J Clin Microbiol. 1997;35(12):3274–3277.
Champion J, Taylor A, Hutchinson S, et al. Incidence of hepatitis C virus infection and associated risk factors among Scottish prison inmates: a cohort study. Am J Epidemiol. 2004;159(5):514–519.
Pallas J, Farinas-Alvarez C, Prieto D, Llorca J, Delgado-Rodriguez M. Risk factors for monoinfections and coinfections with HIV, hepatitis B and hepatitis C viruses in northern Spanish prisoners. Epidemiol Infect. 1999;123(1):95–102.
Esteban J, Lopez-Talavera J, Genesca J, et al. High rate of infectivity and liver disease in blood donors with antibodies to hepatitis C virus. Ann Intern Med. 1991;115(6):443–449.
Meyer R, Gordon S. Epidemiology of hepatitis C virus infection in a suburban Detroit community. Am J Gastroenterol. 1991;86(9):1224–1226.
Samuel M, Doherty P, Bulterys M, Jenison SA. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA. Epidemiol Infect. Dec 2001;127(3):475–484.
Iwamura K, Pronai L, Nishioka K, Watanabe J. Incidence of hepatitis C in chronic liver diseases following tattooing. Orv Hetil. 1992;133(15):923–925.
Entz A, Ruffolo V, Chinveschakitvanich V, Soskolne V, van Griensven GJ. HIV-1 prevalence, HIV-1 subtypes and risk factors among fishermen in the Gulf of Thailand and the Andaman Sea. AIDS. 2000;14(8):1027–1034.
Romanowski B, Preiksaitis J, Campbell P, Fenton J. Hepatitis C seroprevalence and risk behaviors in patients attending sexually transmitted disease clinics. Sex Transm Dis. Jan 2003;30(1):33–38.
Segurado A, Braga P, Etzel A, Cardoso MR. Hepatitis C virus coinfection in a cohort of HIV-infected individuals from Santos, Brazil: seroprevalence and associated factors. AIDS Patient Care STDs. Mar 2004;18(3):135–143.
Zhou F, Ma Z, Hu W, et al. Study on the relationship between hepatitis C virus infection and sharing injection equipment, sexual behavior among injecting drug users. Zhonghua Liu Xing Bing Xue Za Zhi. Apr 2004;25(4):329–332.
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Reyes, Colón, Robles, Matos, Negrón, Marrero, Calderón, and Shepard are with the Center for Addiction Studies, Institute of Addiction, Universidad Central del Caribe, Bayamón, Puerto Rico; Robles and Shepard are with the Caribbean Basin and Hispanic Addiction Technology Transfer Center, Institute of Addiction, Universidad Central del Caribe, Bayamón, Puerto Rico; Rios is with the Retrovirus Research Center, School of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico.
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Reyes, J.C., Colón, H.M., Robles, R.R. et al. Prevalence and Correlates of Hepatitis C Virus Infection among Street-Recruited Injection Drug Users in San Juan, Puerto Rico. J Urban Health 83, 1105–1113 (2006). https://doi.org/10.1007/s11524-006-9109-7
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DOI: https://doi.org/10.1007/s11524-006-9109-7
Keywords
- Hepatitis C
- Injection drug users
- Puerto Rico
- Shooting gallery
- Tattooing