Epidemiology and Infection

Table of Contents - 2009 - Volume 137, Issue 07  

Cambridge Journals Online - CUP Full-Text Page
Epidemiology and Infection (2009), 137:980-987 Cambridge University Press
Copyright © 2008 Cambridge University Press
doi:10.1017/S0950268808001660

Original Papers

Hepatitis

Prevalence and incidence of hepatitis C in injecting drug users attending genitourinary medicine clinics

M. A. BALOGUNa1 c1, N. MURPHYa2, S. NUNNa3, A. GRANTa3, N. J. ANDREWSa3, C. G. TEOa2, M. E. RAMSAYa1 and J. V. PARRYa2a4

a1 Immunisation Department, Health Protection Agency Centre for Infections, London, UK
a2 Virus Reference Department, Health Protection Agency Centre for Infections, London, UK
a3 Statistics, Modelling and Economics Department, Health Protection Agency Centre for Infections, London, UK
a4 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
Article author query
balogun ma [PubMed]  [Google Scholar]
murphy n [PubMed]  [Google Scholar]
nunn s [PubMed]  [Google Scholar]
grant a [PubMed]  [Google Scholar]
andrews nj [PubMed]  [Google Scholar]
teo cg [PubMed]  [Google Scholar]
ramsay me [PubMed]  [Google Scholar]
parry jv [PubMed]  [Google Scholar]

SUMMARY

Surveillance reports and prevalence studies have indicated that injecting drug users (IDUs) contribute more to the hepatitis C epidemic in the United Kingdom than any other risk group. Information on both the prevalence and incidence of hepatitis C in IDUs is therefore essential to understanding the epidemiology of this infection. The prevalence of hepatitis C in specimens from the Unlinked Anonymous Prevalence Monitoring Programme collected in 1995, 1996, 1998, 1999, 2000, and 2001 was determined using residual syphilis serology specimens from IDUs attending 15 genitourinary medicine (GUM) clinics in and outside London. These specimens were tested for antibodies to hepatitis C virus (anti-HCV). Using this cross-sectional design, anti-HCV-negative specimens were tested for HCV RNA to identify incident infections during the ‘window’ period of infection, and thus to estimate HCV incidence. Results of the multivariable analysis showed that there was marked variation in prevalence by clinic (P<0·0001) and age (P<0·0001). Overall the majority of infections were in males and the overall prevalence in injectors declined over the study period from 36·9% to 28·7%. The annual incidence in these injectors was estimated as being 3·01% (95% CI 1·25–6·73). Over the study period HCV incidence decreased by 1·2% per year. Genotyping of the incident infections identified the most common genotype as type 1 with type 3 being more frequently seen after 1998. Of the prevalent infections, genotype 1 was the most common. The study has confirmed a higher prevalence of anti-HCV in IDUs in the London area compared to those outside London. How representative of the current injecting drug user population are IDUs attending GUM clinics is unclear. Even so, such studies allow prevalence and incidence to be estimated in individuals who have ever injected drugs and inform ongoing public health surveillance.

(Accepted November 07 2008)

(Online publication December 23 2008)

Key Words:Genotype; hepatitis C virus; incidence; injecting drug users; prevalence; window period infections

Correspondence:

c1 Author for correspondence: Dr M. A. Balogun, Health Protection Agency, Centre for Infections, Immunisation Department, 61 Colindale Avenue, London NW9 5EQ, UK. (Email: koye.balogun@hpa.org.uk)

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