Risk Factors Associated with HIV and HCV Infection among Injection Drug Users in India

By Liz Highleyman

Infection with blood-borne diseases such as HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) is common among injection drug users (IDUs). Factors that increase the risk of infection have been extensively studied among IDUs in industrialized countries, but less so in the developing world.

As reported at the recent 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention in Sydney, Australia (July 22-25, 2007), researchers examined risk factors for HIV, HBV, and HCV infection among IDUs in 2 states in northeastern India.

Between October 2004 and September 2006, 400 IDUs were enrolled in the study, of whom 398 consented to HIV, HCV, and HBV testing. Serum samples were screened using third generation ELISA test kits. A detailed structured questionnaire was used to record different socio-demographic and injection-related risk factors.

Results

• Of the 398 IDUs screened:

- 43 (10.8%) were HIV-1 antibody positive;
- 190 (47.8%) were infected with HCV;
- 15 (3.8%) had detectable hepatitis B surface antigen (HBsAg).

• Among the 43 HIV positive subjects, 79.1% were HIV-HCV coinfected and 3 (6.9%) were triply infected with HIV, HBV, and HCV.

• Users of heroin (diacetylmorphine) were at significantly higher risk than users of dextropropoxyphene (another opioid drug) for both HCV monoinfection (OR 3.4; P<0.0001) and HIV-HCV coinfection (OR 4.3; P=0.0003).

• Other factors significantly associated with HCV monoinfection and HIV-HCV coinfection were:

- longer duration of injecting career;
- use of multiple injection drugs;
- sharing drug injection equipment with friends;
- sharing containers for preparing injection drugs.

Conclusion

"Apart from the known risk variables among IDUs, type of injecting drugs also influences the transmission pattern among the IDUs," the researchers concluded.

"New policies need to be devised apart from the syringe and needle exchange programmes to halt the high transmission of HIV-HCV among the IDUs," they added. "The finding of this high rate of HIV-HCV coinfection in this cohort of IDUs also makes it crucial to monitor HIV infected IDUs for concurrent infection with HCV."

Regional Medical Research Centre for NE region (Indian Council of Medical Research), Virology, Dibrugarh, India.

08/07/07

Reference
B Borkakoty, J Mahanta, HK Das, and others. Co-infection of HIV, HCV, HBV and the associated risk behaviors among injection drug users in two northeastern states of India. 4th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007), July 22-25, 2007. Sydney, Australia. Abstract MOPEC044.