iconstar paper   Hepatitis C Articles (HCV)  
Back grey arrow rt.gif
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
  Download the PDF here
March 27, 2023
This data does NOT discuss the prevalence of HCV among older IDUs or those with a history of IDU who may remain untested & unidentified or not in care or treatment for HCV - this is all too often overlooked with this annoying emphasis n young that eliminates older people from the discussion. Jules
In conclusion, this systematic review and meta-analysis produced, to our knowledge, the first pooled estimates of HIV and HCV incidence rates derived by use of direct methods among PWID. The low availability of incidence estimates globally, particularly in LMICs, suggests that intensified efforts are urgently needed to keep track of the HIV and HCV epidemics among PWID in these countries. Because PWID often face stigma and discrimination, there is a risk that they will be overlooked in elimination efforts if national data on HIV and HCV incidence remain absent. This gap needs to be addressed to achieve the global goals of eliminating HIV and HCV. Given the higher risks of HIV and HCV acquisition in young versus older PWID and in women versus men who inject drugs, age-appropriate and gender-appropriate prevention and harm reduction measures are also urgently needed to serve these subgroups at high risk. Factors other than age and sex or gender are also likely to be influencing HIV and HCV acquisition risks (eg, types of drugs injected and the context of injection, identifying as men who have sex with men, and engaging in sex work), and research is also needed to synthesise the role of these other factors to better strengthen HIV and HCV prevention responses. We plan to explore some of these factors in future studies.

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.
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.
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; I2=98⋅4%) and pooled HCV incidence was 12⋅1 per 100 person-years (10⋅0-14⋅6; I2=97⋅2%).
Young PWID had a greater risk of HIV (RR 1⋅5, 95% CI 1⋅2-1⋅8; I2=66⋅9%) and HCV (1⋅5, 1⋅3-1⋅8; I2=70⋅6%) acquisition than older PWID.
Women had a greater risk of HIV (RR 1⋅4, 95% CI 1⋅1-1⋅6; I2=55⋅3%) and HCV (1⋅2, 1⋅1-1⋅3; I2=43⋅3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk.
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.
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.
Globally, around 18% of people who inject drugs (PWID) are living with HIV and more than 50% have been infected with hepatitis C virus (HCV).
Given that effective interventions are available, UNAIDS and WHO have recommended policies and targets for ending the HIV/AIDS epidemic and eliminating HCV as a public health threat by 2030.
Monitoring HIV and HCV incidence is key to understanding the scale of these epidemics, tracking progress towards achieving the 2030 UNAIDS and WHO targets, and evaluating the effect of interventions.
Over the past two decades, the incidence rates of HIV and HCV have declined among PWID in some high-income countries (HICs) due to the scale up of harm reduction interventions and, more recently, treatment. Meanwhile, persistently high levels or outbreaks of HIV and HCV among PWID have been reported in other HICs and low-income or middle-income countries (LMICs).
A better understanding of these shifting epidemiological patterns and the availability of data globally are needed to orient surveillance and programming efforts. However, no global study has summarised HIV and HCV incidence among PWID, except for a modelling study that estimated HCV incidence to be 8⋅6 per 100 person-years (95% credible interval 5⋅4-14⋅4) in 2015.

  iconpaperstack View Older Articles   Back to Top   www.natap.org