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Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection

David M. Patrick^*, Mark W. Tyndall, Peter G.A. Cornelisse^¶, Kathy Li, Chris H. Sherlock^**, Michael L. Rekart^*, Steffanie A. Strathdee, Sue L. Currie , Schechter and Michael V. O'Shaughnessy^**

From the *University of British Columbia Centre for Disease Control, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC; Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC; ¶Fred Hutchinson Cancer Research Center, Seattle, WA; **Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC; Johns Hopkins School of Hygiene and Public Health, Baltimore, MD; and University of California, San Francisco Centre for AIDS Prevention Studies, San Francisco, CA

Correspondence to: Dr. David M. Patrick, University of British Columbia Centre for Disease Control, 655 W 12th Ave., Room 2104, Vancouver BC V5Z 4R4; fax 604 660-0197; david.patrick{at}bccdc.hnet.bc.ca

Background: Beginning in 1994, Vancouver experienced an explosive outbreak of HIV infection among injection drug users (IDUs). The objectives of this study were to measure the prevalence and incidence of hepatitis C virus (HCV) infection in this context and to examine factors associated with HCV seroconversion among IDUs.

Methods: IDUs recruited through a study site and street outreach completed interviewer-administered questionnaires covering subjects' characteristics, behaviour, health status and service utilization and underwent serologic testing for HIV and HCV at baseline and semiannually thereafter. A Cox proportional hazards model was used to identify independent correlates of HCV seroconversion.

Results: As of Nov. 30, 1999, 1345 subjects had been recruited into the study cohort. The prevalence of anti-HCV antibodies was 81.6% (95% confidence interval [CI] 79.6% to 83.6%) at enrolment. Sixty-two HCV seroconversions occurred among 155 IDUs who were initially HCV negative and who returned for follow-up, for an overall incidence density rate of 29.1 per 100 person-years (95% CI 22.3 to 37.3). The HCV incidence remained above 16 per 100 person-years over 3 years of observation (December 1996 to November 1999), whereas HIV incidence declined from more than 19 to less than 5 per 100 person-years. Independent correlates of HCV seroconversion included female sex, cocaine use, injecting at least daily and frequent attendance at a needle exchange program.

Interpretation: Because of high transmissibility of HCV among those injecting frequently and using cocaine, the harm reduction initiatives deployed in Vancouver during the study period proved insufficient to eliminate hepatitis C transmission in this population.

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