Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis.

Adelina Artenie, Jack Stone, Hannah Fraser, Daniel Stewart, Chiedozie Arum, Aaron G Lim, Anna L McNaughton, Adam Trickey, Zoe Ward, Daniela Abramovitz, Michel Alary, Jacquie Astemborski, Julie Bruneau, Steven J Clipman, Carla S Coffin, Sara Croxford, Kora DeBeck, Eva Emanuel, Kanna Hayashi, Joumana G Hermez, Daniel Low-Beer, Niklas Luhmann, Gisela Macphail, Lisa Maher, Norah E Palmateer, Eshan U Patel, Rachel Sacks-Davis, Wijnand Van Den Boom, Daniela K van Santen, Josephine G Walker, Matthew Hickman, Peter Vickerman

Journal: The lancet. Gastroenterology & hepatology 2023;8(6):533-552

PMID: 36996853

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender.

METHODS

In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884.

FINDINGS

Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I=66·9%) and HCV (1·5, 1·3-1·8; I=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I=55·3%) and HCV (1·2, 1·1-1·3; I=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk.

INTERPRETATION

Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs.

FUNDING

Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.

Address: Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK. Electronic address: [email protected].; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Public Health Speciality Training Programme, South West, Bristol, UK.; Yale School of Medicine, Yale University, New Haven, CT, USA.; School of Medicine, University of California, San Diego, CA, USA.; Centre de recherche du CHU de Québec-Université Laval, Québec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada.; Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA.; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; Public Health and Clinical Directorate, UK Health Security Agency, London, UK.; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada; BC Centre on Substance Use, Vancouver, BC, Canada.; Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK.; BC Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.; Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.; Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland.; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Infectious Diseases, CUPS Liver Clinic, Calgary, AB, Canada.; Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia.; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.; Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.; Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia.; Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

DOI: 10.1016/S2468-1253(23)00018-3

Link outs

Free resources

Full Text Sources:

Medical:

https://medlineplus.gov/hepatitisc.html

Miscellaneous:

https://assays.cancer.gov/CPTAC-1496

Research Materials:

https://antibodies.cancer.gov/detail/CPTC-PTEN-4

MeSH Terms: Male, Humans, Female, Hepacivirus, Substance Abuse, Intravenous, Drug Users, Incidence, HIV Infections, Canada, Hepatitis C