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HCV Infection Prevalence Lower Than Expected among 18–40-Year-Old Injection Drug Users in San Diego, CA

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Abstract

San Diego, California shares the world’s busiest land border crossing with Tijuana, Mexico—a city where 95 % of injection drug users (IDUs) test hepatitis C virus (HCV) antibody-positive. Yet, little is known about the prevalence and risk behaviors for HCV among IDUs in San Diego. In 2009–2010, 18–40-year-old IDUs in San Diego County completed a risk assessment interview and serologic testing for HCV and HIV infection. Recruitment involved respondent-driven sampling, venue-based sampling at a syringe exchange program, and convenience sampling. Correlates of HCV infection were identified by multivariable logistic regression. Among 510 current IDUs, 26.9 % (95 % CI 23.0–30.7 %) and 4.2 % (95 % CI 2.4–5.9 %) had been infected with HCV and HIV, respectively. Overall, median age was 28 years; 74 % were male; 60 % white and 29 % Hispanic; and 96 % were born in the U.S. Median years of injecting was 6; 41 % injected daily; 60 % injected heroin most often; 49 % receptively shared syringes and 68 % shared other injection paraphernalia; and only 22 % reported always using new syringes in the past 3 months. Two thirds had ever traveled to Mexico and 19 % injected in Mexico. HCV infection was independently associated with sharing injection paraphernalia (adjusted odds ratio [AOR] = 1.69) and SEP use (AOR = 2.17) in the previous 3 months, lifetime history of drug overdose (AOR = 2.66), and increased years of injecting (AOR = 2.82, all P values <0.05). Controlling for recruitment method did not alter results. HCV infection prevalence among IDUs in San Diego was modest compared to other US cities and much lower than Tijuana. Given that known individual-level HCV risk factors were common in San Diego, the city’s lower HCV prevalence might be due to differences in social and structural factors between the cities.

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References

  1. Centers for Disease Control and Prevention. Division of viral hepatitis—statistics and surveillance. Disease burden from viral hepatitis A, B, and C in the United States 2008. Available at: http://www.cdc.gov/hepatitis/HCV/StatisticsHCV.htm. Accessed January 29, 2012.

  2. Amon JJ, Garfein RS, Ahdieh-Grant L, et al. Prevalence of hepatitis C virus infection among injection drug users in the United States, 1994–2004. Clin Infect Dis. 2008; 46(12): 1852–1858.

    Article  PubMed  Google Scholar 

  3. Fisher DG, Reynolds GL, Jaffe A, Perez MJ. Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California. J Addict Dis. 2006; 25(2): 25–32.

    Article  PubMed  Google Scholar 

  4. Stopka TJ, Marshall C, Bluthenthal RN, Webb DS, Truax SR. HCV and HIV counseling and testing integration in California: an innovative approach to increase HIV counseling and testing rates. Public Health Rep. 2007; 122: 68–73.

    PubMed  Google Scholar 

  5. Thomas DL, Vlahov D, Solomon L, et al. Correlates of hepatitis-C virus-infections among injection-drug users. Medicine. 1995; 74(4): 212–220.

    Article  PubMed  CAS  Google Scholar 

  6. Hagan H, Thiede H, Weiss NS, Hopkins SG, Duchin JS, Alexander ER. Sharing of drug preparation equipment as a risk factor for hepatitis C. Am J Public Health. 2001; 91(1): 42–46.

    Article  PubMed  CAS  Google Scholar 

  7. Hahn JA, Page-Shafer K, Ford J, Paciorek A, Lum PJ. Traveling young injection drug users at high risk for acquisition and transmission of viral infections. Drug Alcohol Depend. 2008; 93(1–2): 43–50.

    Article  PubMed  Google Scholar 

  8. Hahn JA, Page-Shafer K, Lum PJ, 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.

    Article  PubMed  CAS  Google Scholar 

  9. Bair RM, Baillargeon JG, Kelly PJ, et al. Prevalence and risk factors for hepatitis C virus infection among adolescents in detention. Arch Pediatr Adolesc Med. 2005; 159(11): 1015–1018.

    Article  PubMed  Google Scholar 

  10. Hagan H, Jarlais DCD, Stern R, et al. HCV synthesis project: preliminary analyses of HCV prevalence in relation to age and duration of injection. Int J Drug Policy. 2007; 18(5): 341–351.

    Article  PubMed  Google Scholar 

  11. Centers for Disease Control and Prevention. Morbidity and mortality weekly report. Surveillance for acute viral hepatitis—United States, 2007. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5803a1.htm?s_cid=ss5803a1_e. Accessed January 29, 2012.

  12. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006; 144(10): 705–714.

    Article  PubMed  Google Scholar 

  13. Hahn JA, Page-Shafer K, Lum PJ, et al. Hepatitis C virus seroconversion among young injection drug users: relationships and risks. J Infect Dis. 2002; 186(11): 1558–1564.

    Article  PubMed  Google Scholar 

  14. Thorpe LE, Ouellet LJ, 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.

    Article  PubMed  Google Scholar 

  15. Hagan H, Pouget ER, Williams IT, et al. Attribution of hepatitis C virus seroconversion risk in young injection drug users in 5 US cities. J Infect Dis. 2010; 201(3): 378–385.

    Article  PubMed  Google Scholar 

  16. Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health. 1996; 86(5): 655–661.

    Article  PubMed  CAS  Google Scholar 

  17. White EF, Garfein RS, Brouwer KC, et al. Prevalence of hepatitis C virus and HIV infection among injection drug users in two Mexican cities bordering the US. Salud Publica De Mexico. 2007; 49(3): 165–172.

    Article  PubMed  Google Scholar 

  18. SANDAG. San Diego Region–Baja California Port of entry border crossing statistics. 2009. Available at: http://www.sandag.org/uploads/publicationid/publicationid_1424_9306.pdf. Accessed January 29, 2012.

  19. Zeldis JB, Jain S, Kuramoto IK, et al. Seroepidemiology of viral-infections among intravenous-drug-users in Northern California. West J Med. 1992; 156(1): 30–35.

    PubMed  CAS  Google Scholar 

  20. Friedman SR, Tempalski B, Cooper H, et al. Estimating numbers of injecting drug users in metropolitan areas for structural analyses of community vulnerability and for assessing relative degrees of service provision for injecting drug users. J Urban Health. 2004; 81(3): 377–400.

    Article  PubMed  Google Scholar 

  21. Gunn RA, Murray PJ, Ackers ML, Hardison WGM, Margolis HS. Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic—rationale for integrating services. Sex Transm Dis. 2001; 28(3): 166–170.

    Article  PubMed  CAS  Google Scholar 

  22. Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997; 44(2): 174–199.

    Article  Google Scholar 

  23. Heckathorn DD. Extensions of respondent-driven sampling: analyzing continuous variables and controlling for differential recruitment, Sociological Methodology, vol. 37. Oxford: Blackwell Publishing; 2007: 151–208.

    Google Scholar 

  24. Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005; 19: S67–S72.

    Article  PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention. Hepatitis C Information for health professionals—laboratory testing. Available at: http://www.cdc.gov/hepatitis/HCV/LabTesting.htm. Accessed January 29, 2012.

  26. Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S, Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. Am J Epidemiol. 1999; 149(3): 203–213.

    Article  PubMed  CAS  Google Scholar 

  27. Patrick DM, Tyndall MW, Cornelisse PGA, et al. Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. Can Med Assoc J. 2001; 165(7): 889–895.

    CAS  Google Scholar 

  28. Grau LE, Bluthenthal RN, Marshall P, Singer M, Heimer R. Psychosocial and behavioral differences among drug injectors who use and do not use syringe exchange programs. AIDS Behav. 2005; 9(4): 495–504.

    Article  PubMed  Google Scholar 

  29. Huo DZ, Ouellet LJ. Needle exchange and injection-related risk behaviors in Chicago—a longitudinal study. J Acquir Immune Defic Syndr. 2007; 45(1): 108–114.

    Article  PubMed  Google Scholar 

  30. Zhao M, Du J, Lu GH, et al. HIV sexual risk behaviors among injection drug users in Shanghai. Drug Alcohol Depend. 2006; 82: S43–S47.

    Article  PubMed  Google Scholar 

  31. Ochoa KC, Davidson PJ, Evans JL, Hahn JA, Page-Shafer K, Moss AR. Heroin overdose among young injection drug users in San Francisco. Drug Alcohol Depend. 2005; 80(3): 297–302.

    Article  PubMed  Google Scholar 

  32. Seal KH, Kral AH, Gee L, et al. Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998–1999. Am J Public Health. 2001; 91(11): 1842–1846.

    Article  PubMed  CAS  Google Scholar 

  33. Brouwer KC, Lozada R, Cornelius WA, et al. Deportation along the US-Mexico border: its relation to drug use patterns and accessing care. J Immigr Minor Heal. 2009; 11(1): 1–6.

    Article  CAS  Google Scholar 

  34. Gelpi-Acosta C, Hagan H, Jenness SM, Wendel T, Neaigus A. Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City: a mixed-methods analysis. Harm Reduct J. 2011; 8: 28.

    Article  PubMed  Google Scholar 

  35. Legislación Ny. Consejo Nacional contras las Adicciones. Available at: http://www.conadic.salud.gob.mx/interior/normas.html. Accessed January 29, 2012.

  36. Vastag B. 5 Years After: Portugal's drug decriminalization policy shows positive results. Scientific America. Available at: http://www.scientificamerican.com/article.cfm?id=portugal-drug-decriminalization. Accessed January 29, 2012.

  37. Cooper H, Moore L, Gruskin S, Krieger N. The impact of a police drug crackdown on drug injectors' ability to practice harm reduction: a qualitative study. Soc Sci Med. 2005; 61(3): 673–684.

    Article  PubMed  Google Scholar 

  38. Maher L, Dixon D. Policing and public health—law enforcement and harm minimization in a street-level drug market. Br J Criminol. 1999; 39(4): 488–512.

    Article  Google Scholar 

  39. Miller CL, Firestone M, Ramos R, et al. Injecting drug users' experiences of policing practices in two Mexican-US border cities: public health perspectives. Int J Drug Policy. 2008; 19(4): 324–331.

    Article  PubMed  Google Scholar 

  40. Des Jarlais DC, Paone D, Milliken J, et al. Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: a quasi-randomised trial. Lancet. 1999; 353(9165): 1657–1661.

    Article  PubMed  CAS  Google Scholar 

  41. Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. Risk behaviors by audio computer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drug users. AIDS Educ Prev. 2002; 14(5): 367–378.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors greatly appreciate the support of the University of California San Diego, Antiviral Research Center for the use of its clinical facilities and HIV/HCV NAT testing; research activities performed by Philippe Duhaime, Maureen Clark, Katherine Banares, Nicholas Aldridge, Carlos Vera, Amanpreet Sandhu, and Amelia Poquette; laboratory guidance provided by DeeDee Pacheco; and the participants who volunteered their time for the study. This study was funded through a contract (#200-2007-21016) from the Centers for Disease Control and Prevention. Support for additional HIV and HCV testing was provided by grants from the National Institutes of Health (AI36214, AI074621, and AI007384) and the California HIV/AIDS Research Program (RN07-SD-702).

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Division of Global Public Health, School of Medicine, University of California, San Diego, CA, USA

    Richard S. Garfein, Amanda Rondinelli, Richard F. W. Barnes, Jazmine Cuevas, Mitcheal Metzner, Michele Velasquez & David Rodriguez

  2. Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Meredith Reilly, Jian Xing & Eyasu H. Teshale

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  1. Richard S. Garfein
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Correspondence to Richard S. Garfein.

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Garfein, R.S., Rondinelli, A., Barnes, R.F.W. et al. HCV Infection Prevalence Lower Than Expected among 18–40-Year-Old Injection Drug Users in San Diego, CA. J Urban Health 90, 516–528 (2013). https://doi.org/10.1007/s11524-012-9728-0

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