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HCV & HIV Prevalence in NYC Drug Rehab Facility
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"HCV AND HIV INFECTION AMONG NON-INJECTING DRUG ABUSERS ADMITTED TO A RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY IN NEW YORK CITY"
Reported by Jules Levin
Elizabeth Ross, NYU School of Medicine, New York, NY; Robert F Raicht, VA New York Harbor Healthcare System & NYU School of Medicine, New York, NY; Frank Dominelli, Odyssey House, New York, NY; Edmund J Bini, VA New York Harbor Healthcare System & NYU School of Medicine, New York, NY
---The prevalence of HCV infection among HIV positive patients was 38.2%, while the prevalence of HIV infection among those with HCV was 22.4%...HCV prevalence 79% in IDUs...26% HIV prevalence in IDUs.---
Background: Although the prevalence of HCV and HIV infection among injection drug users has been well studied, less is known about the prevalence of these infections in non-injecting drug users. The aims of this study were to evaluate the prevalence of HCV and HIV infection among non-injection substance abusers, and to determine if intranasal cocaine or heroin use is associated with an increased risk of HCV infection.
We reviewed the medical records of 531 men and women admitted over a 1-year period to Odyssey House, a residential substance abuse treatment facility in New York City. All patients admitted to this facility underwent a detailed medical, psychiatric, and substance evaluation, as well as HCV and HIV testing.
Among the 531 subjects, the mean age was 32.7 ± 12.4 years, 30.3% were female, and the majority were non-Hispanic blacks (59.7%) or Hispanics (34.5%).
A total of 57.7% were referred for substance abuse rehabilitation from the criminal justice system, and 35.4% of subjects were in jail within 30 days of admission.
The major substance that was abused was cocaine in 35.1%, marijuana in 24.6%, and heroin in 13.2%, and only 8.6% of persons reported injection drug use.
The overall prevalence of HCV infection was 14.8%, and it was significantly lower in non-injection drug users compared with those that have injected drugs (7.6% vs. 79.1%, p < 0.001). The overall prevalence of HIV infection in our population was 9.4%, and non-injection drug users were significantly less likely to be HIV positive compared with those that have injected drugs (7.2% vs. 26.2%, p < 0.001).
The prevalence of HCV infection among HIV positive patients was 38.2%, while the prevalence of HIV infection among those with HCV was 22.4%. Coinfection with both HCV/HIV was present in 3.6% of individuals, including 0.9% of non-injection drug users and 22.5% of those that have injected drugs (p < 0.001).
Among subjects that have never injected drugs, the prevalence of HCV infection was significantly higher in individuals that have used intranasal cocaine or heroin compared with those that have never used these drugs (11.8% vs. 5.2%, p = 0.02). In contrast, the prevalence of HIV infection among non-injection drug users did not differ between those who did and those that did not use intranasal cocaine/heroin (7.0% vs. 7.4%, p = 0.89).
The authors concluded that the prevalence of HCV and HIV infection among non-injection drug users is higher than in the general population. The high prevalence of HCV infection in non-injection drug users who have snorted cocaine or heroin suggests that intranasal cocaine/heroin use may be a risk factor for HCV infection, but further studies are necessary.
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