Injection drug users with HCV history at risk for additional infections
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An outbreak study based in West Virginia showed that people who inject drugs and have had hepatitis C are at risk for additional complications of injection drug use, including HIV hepatitis A and hepatitis B infection.
“CDC previously documented that hepatitis C virus infection preceded HIV infection in an outbreak of HIV among people who inject drugs in Massachusetts from 2015-2018 at a median of 45 months, or more than 3 1/2 years prior to HIV infection,” Danae Bixler, MD, MPH, medical officer in CDC’s Division of Viral Hepatitis, told Healio.
She said that she and her colleagues were also aware of a large HCV outbreak preceding the HIV outbreak in Scott County, Indiana, among people who inject drugs in 2015. She said that in some cases, the HCV outbreak led the HIV outbreak by 5 years.
“We wanted to know if, similarly, hepatitis C infection preceded the more recent HIV outbreak among persons who inject drugs (PWID) in West Virginia as part of a larger study of access to services among HIV cases,” she said, adding that they also wanted to assess coinfections with HBV and HAV to better understand the natural history of viral hepatitis and HIV infection among persons who inject drugs.
Bixler and colleagues performed a cross-match using data from the West Virginia Electronic Disease Surveillance System and the enhanced HIV/AIDS Reporting System to identify outbreak cases with a laboratory test indicating current or past HCV, HBV or HAV infection.
According to the study, outbreak cases were defined as confirmed HIV diagnoses on or after Jan. 1, 2019, among PWID who lived in Kanawha County at the time of HIV diagnosis. They were included in the study if they had at least one health care encounter at Charleston Area Medical Center or at West Virginia Health Right during the year before HIV diagnosis through June 18, 2021.
In total, 65 (97%) of 67 HIV cases met inclusion criteria. According to the study, most cases were seropositive for HCV infection (n = 61; 94%) with detectable HCV RNA levels (n = 55; 85%).
Of the 61 people diagnosed with past or current HCV infection, this diagnosis preceded HIV diagnosis for 50 (82%), with a median interval of 46 months (interquartile range [IQR] = 29-71), whereas three (5%) had HCV infection diagnosed 4 to 12 months after HIV diagnosis and eight (13%) had an HCV diagnosis simultaneously or within 1 week after HIV diagnosis. A history of HAV (n = 11; 17%) or HBV (n = 10; 15%) infection was also detected exclusively among persons seropositive for HCV.
According to the study, HAV diagnosis preceded HIV diagnosis in all cases by a median of 22 months (IQR = 15-31), whereas HBV infection was detected before or on the date of HIV diagnosis for seven (70%) cases. Among these cases, the median time from detection of HBV infection to HIV was 30 months (IQR = 2-67).
The researchers said only 22 (34%) people had received at least one dose of HBV vaccine, including two people with a history of HBV infection. As many as 27 (42%) of these people may have been HBV susceptible, including 19 (29%) with serologic markers indicating susceptibility with record of vaccination, as well as an another eight (12%) who had no HBV test results or immunization records.
“People who inject drugs and have ever had HCV infection are at risk for further complications of injection drug use, including HIV infection and HAV and HBV infection,” Bixler said.
“To protect their individual health and prevent transmission of HIV and viral hepatitis, they should be offered medication for opioid use disorder (if they have opioid use disorder), access to syringe services programs, testing and treatment for HIV and viral hepatitides, access to pre-exposure prophylaxis to prevent HIV, and vaccination for hepatitis A and hepatitis B.”
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