1887
Research article Open Access
Like 0

Abstract

Background

Monitoring hepatitis C virus (HCV) incidence is important for assessing intervention impact. Longitudinal studies of people who inject drugs (PWID), using repeated biological tests, are costly; alternatively, incidence can be estimated using biological markers of recent infection in cross-sectional studies.

Aim

We aimed to compare incidence estimates obtained from two different biological markers of recent infection in a cross-sectional study to inform monitoring approaches for HCV elimination strategies.

Method

Samples from an unlinked anonymous bio-behavioural survey of PWID were tested for two recent infection markers: HCV RNA with anti-HCV negative (‘RNA’) and low-avidity anti-HCV with HCV RNA present (‘avidity’). These two markers were used separately and in combination to estimate HCV incidence.

Results

Between 2011 and 2013, 2,816 anti-HIV-negative PWID (25% female) who had injected during the preceding year were either HCV-negative or had one of the two markers of recent infection: 57 (2.0%) had the RNA marker and 90 (3.2%) the avidity marker. The two markers had similar distributions of risk and demographic factors. Pooled estimated incidence was 12.3 per 100 person-years (pyrs) (95% credible interval: 8.8–17.0) and not significantly different to avidity-only (p = 0.865) and RNA-only (p = 0.691) estimates. However, the RNA marker is limited by its short duration before anti-HCV seroconversion and the avidity marker by uncertainty around its duration.

Conclusion

Both markers have utility in monitoring HCV incidence among PWID. When HCV transmission is high, one marker may provide an accurate estimate of incidence; when it is low or decreasing, a combination may be required.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.47.1700635
2018-11-22
2019-06-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.47.1700635
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/47/eurosurv-23-47-5.html?itemId=/content/10.2807/1560-7917.ES.2018.23.47.1700635&mimeType=html&fmt=ahah

References

  1. Di Bisceglie AM. Hepatitis C. Lancet. 1998;351(9099):351-5.  https://doi.org/10.1016/S0140-6736(97)07361-3  PMID: 9652633 
  2. Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health. 1996;86(5):655-61.  https://doi.org/10.2105/AJPH.86.5.655  PMID: 8629715 
  3. Public Health England, Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland. Shooting Up: Infections among people who inject drugs in the UK, 2015. London: Public Health England; November 2016. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/567231/Shooting_Up_2016_Update.pdf
  4. Hickman M, Hope V, Brady T, Madden P, Jones S, Honor S, et al. Hepatitis C virus (HCV) prevalence, and injecting risk behaviour in multiple sites in England in 2004. J Viral Hepat. 2007;14(9):645-52.  https://doi.org/10.1111/j.1365-2893.2007.00855.x  PMID: 17697017 
  5. MacDonald M, Crofts N, Kaldor J. Transmission of hepatitis C virus: rates, routes, and cofactors. Epidemiol Rev. 1996;18(2):137-48.  https://doi.org/10.1093/oxfordjournals.epirev.a017921  PMID: 9021308 
  6. World Health Organization (WHO). Global health sector strategy on viral hepatitis, 2016-2021. Towards Ending Viral hepatitis. Geneva: WHO; 2016.
  7. Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, et al. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PLoS One. 2014;9(7):e103345.  https://doi.org/10.1371/journal.pone.0103345  PMID: 25068274 
  8. Hope VD, Hickman M, Ngui SL, Jones S, Telfer M, Bizzarri M, et al. Measuring the incidence, prevalence and genetic relatedness of hepatitis C infections among a community recruited sample of injecting drug users, using dried blood spots. J Viral Hepat. 2011;18(4):262-70.  https://doi.org/10.1111/j.1365-2893.2010.01297.x  PMID: 20456636 
  9. Page-Shafer K, Pappalardo BL, Tobler LH, Phelps BH, Edlin BR, Moss AR, et al. Testing strategy to identify cases of acute hepatitis C virus (HCV) infection and to project HCV incidence rates. J Clin Microbiol. 2008;46(2):499-506.  https://doi.org/10.1128/JCM.01229-07  PMID: 18032621 
  10. Bernardin F, Stramer SL, Rehermann B, Page-Shafer K, Cooper S, Bangsberg DR, et al. High levels of subgenomic HCV plasma RNA in immunosilent infections. Virology. 2007;365(2):446-56.  https://doi.org/10.1016/j.virol.2007.04.003  PMID: 17493654 
  11. Glynn SA, Wright DJ, Kleinman SH, Hirschkorn D, Tu Y, Heldebrant C, et al. Dynamics of viremia in early hepatitis C virus infection. Transfusion. 2005;45(6):994-1002.  https://doi.org/10.1111/j.1537-2995.2005.04390.x  PMID: 15934999 
  12. Netski DM, Mosbruger T, Depla E, Maertens G, Ray SC, Hamilton RG, et al. Humoral immune response in acute hepatitis C virus infection. Clin Infect Dis. 2005;41(5):667-75.  https://doi.org/10.1086/432478  PMID: 16080089 
  13. Cullen KJ, Hope VD, Croxford S, Shute J, Ncube F, Parry JV. Factors associated with recently acquired hepatitis C virus infection in people who inject drugs in England, Wales and Northern Ireland: new findings from an unlinked anonymous monitoring survey. Epidemiol Infect. 2015;143(7):1398-407.  https://doi.org/10.1017/S0950268814002040  PMID: 25119383 
  14. Patel EU, Cox AL, Mehta SH, Boon D, Mullis CE, Astemborski J, et al. Use of hepatitis C virus (HCV) immunoglobulin G antibody avidity as a biomarker to estimate the population-level incidence of HCV infection. J Infect Dis. 2016;214(3):344-52.  https://doi.org/10.1093/infdis/jiw005  PMID: 26768250 
  15. Chawla A, Murphy G, Donnelly C, Booth CL, Johnson M, Parry JV, et al. Human immunodeficiency virus (HIV) antibody avidity testing to identify recent infection in newly diagnosed HIV type 1 (HIV-1)-seropositive persons infected with diverse HIV-1 subtypes. J Clin Microbiol. 2007;45(2):415-20.  https://doi.org/10.1128/JCM.01879-06  PMID: 17151211 
  16. Rodella A, Galli C, Terlenghi L, Perandin F, Bonfanti C, Manca N. Quantitative analysis of HBsAg, IgM anti-HBc and anti-HBc avidity in acute and chronic hepatitis B. J Clin Virol. 2006;37(3):206-12.  https://doi.org/10.1016/j.jcv.2006.06.011  PMID: 16893678 
  17. Gaudy-Graffin C, Lesage G, Kousignian I, Laperche S, Girault A, Dubois F, et al. Use of an anti-hepatitis C virus (HCV) IgG avidity assay to identify recent HCV infection. J Clin Microbiol. 2010;48(9):3281-7.  https://doi.org/10.1128/JCM.00303-10  PMID: 20610669 
  18. Shepherd SJ, Kean J, Hutchinson SJ, Cameron SO, Goldberg DJ, Carman WF, et al. A hepatitis C avidity test for determining recent and past infections in both plasma and dried blood spots. J Clin Virol. 2013;57(1):29-35.  https://doi.org/10.1016/j.jcv.2013.01.002  PMID: 23369886 
  19. Klimashevskaya S, Obriadina A, Ulanova T, Bochkova G, Burkov A, Araujo A, et al. Distinguishing acute from chronic and resolved hepatitis C virus (HCV) infections by measurement of anti-HCV immunoglobulin G avidity index. J Clin Microbiol. 2007;45(10):3400-3.  https://doi.org/10.1128/JCM.01012-07  PMID: 17715377 
  20. Murphy G, Parry JV. Assays for the detection of recent infections with human immunodeficiency virus type 1. Euro Surveill. 2008;13(36):13. PMID: 18775293 
  21. Craine N, Hickman M, Parry JV, Smith J, Walker AM, Russell D, et al. Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size. Epidemiol Infect. 2009;137(9):1255-65.  https://doi.org/10.1017/S095026880900212X  PMID: 19224654 
  22. Judd A, Hickman M, Jones S, McDonald T, Parry JV, Stimson GV, et al. Incidence of hepatitis C virus and HIV among new injecting drug users in London: prospective cohort study. BMJ. 2005;330(7481):24-5.  https://doi.org/10.1136/bmj.38286.841227.7C  PMID: 15533854 
  23. Noone A, Durante AJ, Brady AR, Majid F, Swan AV, Parry JV, et al. HIV infection in injecting drug users attending centres in England and Wales, 1990-1991. AIDS. 1993;7(11):1501-7.  https://doi.org/10.1097/00002030-199311000-00015  PMID: 8280418 
  24. Hope VD, Judd A, Hickman M, Sutton A, Stimson GV, Parry JV, et al. HIV prevalence among injecting drug users in England and Wales 1990 to 2003: evidence for increased transmission in recent years. AIDS. 2005;19(11):1207-14.  https://doi.org/10.1097/01.aids.0000176222.71355.a1  PMID: 15990575 
  25. Daniel HD, Grant PR, Garson JA, Tedder RS, Chandy GM, Abraham P. Quantitation of hepatitis C virus using an in-house real-time reverse transcriptase polymerase chain reaction in plasma samples. Diagn Microbiol Infect Dis. 2008;61(4):415-20.  https://doi.org/10.1016/j.diagmicrobio.2008.04.001  PMID: 18486403 
  26. Brookmeyer R, Laeyendecker O, Donnell D, Eshleman SH. Cross-sectional HIV incidence estimation in HIV prevention research. J Acquir Immune Defic Syndr. 2013;63(Suppl 2):S233-9.  https://doi.org/10.1097/QAI.0b013e3182986fdf  PMID: 23764641 
  27. Maher L, Jalaludin B, Chant KG, Jayasuriya R, Sladden T, Kaldor JM, et al. Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Addiction. 2006;101(10):1499-508.  https://doi.org/10.1111/j.1360-0443.2006.01543.x  PMID: 16968352 
  28. Lucidarme D, Bruandet A, Ilef D, Harbonnier J, Jacob C, Decoster A, et al. Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France. Epidemiol Infect. 2004;132(4):699-708.  https://doi.org/10.1017/S095026880400247X  PMID: 15310172 
  29. Hagan H, Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. Am J Public Health. 1995;85(11):1531-7.  https://doi.org/10.2105/AJPH.85.11.1531  PMID: 7485666 
  30. Ruan Y, Qin G, Yin L, Chen K, Qian H-Z, Hao C, et al. Incidence of HIV, hepatitis C and hepatitis B viruses among injection drug users in southwestern China: a 3-year follow-up study. AIDS. 2007;21(Suppl 8):S39-46.  https://doi.org/10.1097/01.aids.0000304695.54884.4f  PMID: 18172390 
  31. Aceijas C, Hickman M, Donoghoe MC, Burrows D, Stuikyte R. Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia. Addiction. 2007;102(8):1244-50.  https://doi.org/10.1111/j.1360-0443.2007.01848.x  PMID: 17565564 
  32. Tsui JI, Evans JL, Lum PJ, Hahn JA, Page K. Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users. JAMA Intern Med. 2014;174(12):1974-81.  https://doi.org/10.1001/jamainternmed.2014.5416  PMID: 25347412 
  33. Pouget ER, Hagan H, Des Jarlais DC. Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment. Addiction. 2012;107(6):1057-65.  https://doi.org/10.1111/j.1360-0443.2011.03765.x  PMID: 22168373 
  34. Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;376(9737):268-84.  https://doi.org/10.1016/S0140-6736(10)60743-X  PMID: 20650523 
  35. Hope VD, Harris RJ, De Angelis D, Croxford S, Marongiu A, Parry JV, et al. Two decades of successes and failures in controlling the transmission of HIV through injecting drug use in England and Wales, 1990 to 2011. Euro Surveill. 2014;19(14):20762.  https://doi.org/10.2807/1560-7917.ES2014.19.14.20762  PMID: 24739984 
  36. Roy E, Boudreau JF, Boivin JF. Hepatitis C virus incidence among young street-involved IDUs in relation to injection experience. Drug Alcohol Depend. 2009;102(1-3):158-61.  https://doi.org/10.1016/j.drugalcdep.2009.01.006  PMID: 19251382 
  37. Platt L, Sutton AJ, Vickerman P, Koshkina E, Maximova S, Latishevskaya N, et al. Measuring risk of HIV and HCV among injecting drug users in the Russian Federation. Eur J Public Health. 2009;19(4):428-33.  https://doi.org/10.1093/eurpub/ckp041  PMID: 19349288 
  38. Public Health England (PHE), Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland. Hepatitis C in the UK. 2016 report. London: PHE; July 2016. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/565459/Hepatitis_C_in_the_UK_2016_report.pdf
  39. Xia Y, Seaman S, Hickman M, Macleod J, Robertson R, Copeland L, et al. Factors affecting repeated cessations of injecting drug use and relapses during the entire injecting career among the Edinburgh Addiction Cohort. Drug Alcohol Depend. 2015;151:76-83.  https://doi.org/10.1016/j.drugalcdep.2015.03.005  PMID: 25869544 
  40. Winter RJ, Young JT, Stoové M, Agius PA, Hellard ME, Kinner SA. Resumption of injecting drug use following release from prison in Australia. Drug Alcohol Depend. 2016;168:104-11.  https://doi.org/10.1016/j.drugalcdep.2016.08.640  PMID: 27635997 
  41. Arnold BF, Hogan DR, Colford JMJ Jr, Hubbard AE. Simulation methods to estimate design power: an overview for applied research. BMC Med Res Methodol. 2011;11(94):94.  https://doi.org/10.1186/1471-2288-11-94  PMID: 21689447 
/content/10.2807/1560-7917.ES.2018.23.47.1700635
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error