icon-    folder.gif   Conference Reports for NATAP  
  21st Conference on Retroviruses and
Opportunistic Infections
Boston, MA March 3 - 6, 2014
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Safety and Efficacy of IFN-free, Sofosbuvir/RBV Therapy in HIV/HCV Liver Transplanted Patients
  Prevalence and Risk Factors of Hepatitis C Virus Infection in China's National Methadone Program
Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
Cynthia X. Shi1,2, Changhe Wang1, Keming Rou1, Enwu Liu1, Yan Zhao1, Xiaobin Cao1, Wei Luo1, Zunyou Wu1! !
1 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
2 Department of Epidemiology, Harvard School of Public Health, Boston, MA


Program abstract-
Approximately 13 million people in China are infected with Hepatitis C virus (HCV), while China has over 3 million injection drug users (IDUs). Established in 2004, the Chinese National Methadone Maintenance Treatment (MMT) Program has expanded to become the world's largest drug treatment network. Despite the large HCV-infected population in China, HCV prevalence in the National MMT Program has not been reported. We sought to assess the prevalence and risk factors of HCV infection among clients in the National MMT Program in China.
Methodology: We conducted a cross-sectional HCV seroprevalence study of all adults at enrollment into the National MMT Program from March 2004 to December 2012. The National MMT Program has 756 sites in 28 provinces. Clients provided information on gender, age, ethnicity, marital status, occupation, drug use, and injecting and needle sharing behaviors using a standardized form. Clients were screened for HIV and HCV. Local providers uploaded daily records into a real-time, online central data system. We used univariate and multivariate logistic regression analyses to determine risk factors for HCV infection.
Results: Among 304,658 clients, 166,343 (54.7%) were HCV-infected, 17,670 (5.8%) were HIV-infected, and 14,014 (4.6%) were HIV-HCV co-infected.
HCV prevalence among newly enrolled clients declined each year: 67.6% in 2005, 62.9% in 2006, 61.6% in 2007, 59.7% in 2008, 55.0% in 2009, 50.3% in 2010, 50.1% in 2011, and 46.6% in 2012. Figure 1 presents the widespread geographical variation of HCV prevalence; five provinces reported HCV prevalence above 70% and 19 provinces reported HCV prevalence above 50%. The overall prevalence of IDU was 66.8%, and the distribution closely mirrored HCV infections (Figure 1). Univariate risk factors for HCV infection were female gender, age 30-45 years, Uyghur or Zhuang ethnicity, unmarried, unemployed, IDU, and drug use history >3 years. In multivariable analysis, the strongest correlates of HCV infection were IDU (AOR: 8.2) and drug use history >9 years (AOR: 2.0). Other risk factors for HCV infection were female gender (AOR: 1.4), age >30 years (AOR: 1.3), Uyghur or Zhuang ethnicity (AOR: 1.3), unmarried (AOR: 1.2), and unemployed (AOR: 1.1).
Conclusions: HCV prevalence remains high among clients receiving MMT in China, particularly among IDUs. These findings highlight the importance of HCV and HIV screening upon MMT enrollment in China, and suggest integration of services to prevent or reduce IDU practices.