Seroprevalence of anti-hepatitis C virus (anti-HCV) antibody and HCV-related risk in injecting drug users in northern India: Comparison with non-injecting drug users

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Abstract

Aim

The current study was designed to study seroprevalence of anti-hepatitis C virus (anti-HCV) antibody in injecting drug users (IDUs) and non-injecting drug users (non-IDUs) with or without other HCV-related risk behaviour.

Materials and methods

Serum of male inpatients of the three groups in a tertiary-care hospital in north India was screened for anti-HCV antibody by enzyme-linked immunosorbent assay (ELISA) for two years. The presence of risk behaviours or risk exposure (sharing needle or other drug-related paraphernalia, multiple sex partners, unprotected sex with commercial sex workers/strangers, and blood transfusion) was assessed with the risk questionnaire.

Results

One-hundred and three IDUs (n = 103), non-IDUs with other HCV-related risk (n = 124) and non-IDUs without other HCV-related risk (n = 245) were screened (mean age 31.2 (SD = 7.92), 32.6 (SD = 9.98) and 36.9 (SD = 10.63) years, respectively). Almost 46% of the IDUs, 8.1% among the non-IDUs with HCV-related risk and 3.7% among the non-IDUs without HCV-related risk were seropositive for anti-HCV antibody (p < 0.001). A majority of the IDUs have been actively using the drugs (76.7%) for a mean duration of 60.9 months (SD = 57.05) and a majority used injection buprenorphine in combination with promethazine and/or diazepam (70.9%). Other HCV-related risk behaviours were significantly more common among non-IDUs with other HCV-related risk behaviour.

Conclusion

Seroprevalence of anti-HCV antibody is high in IDUs compared to non-IDUs, and it is primarily related to injecting risk behaviour.

Highlights

► Anti-hepatitis C virus (anti-HCV) antibody was detected by ELISA method in 45.6% of injecting drug users (IDUs) attending a regional de-addiction centre in north India. ► In contrast, seroprevalence of anti-HCV antibody was only 5.1% in non injecting drug users (non-IDUs) at the same centre. ► Non-IDUs with other (mostly sex-related) risk behaviour had higher seropositivity of anti-HCV antibody compared to non-IDUs who did not have such risk (8.1% vs. 3.7%, respectively). ► Sharing and repeat use of drug-related paraphernalia and (to a lesser extent) risky sexual behaviour were significantly associated with seropositivity in IDUs. ► Given the baseline community seroprevalence of anti-HCV antibody as around 1–2%, our results raise concern and call for urgent medical, public health and policy-making attention in this area.

Introduction

India has a large number of substance abusers, with an estimated 1.1 million injecting drug users (IDUs) (Basu, 2010). IDU is known to be associated with many medical complications and comorbidities including infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Of these, the first two infections in IDU are well known. HCV infection in IDU is also well documented and researched in western countries. It has come into focus in the Indian scenario only recently. Nonetheless, even this recent data strongly suggest the gravity of the situation and the need for further systematic information. According to one recent review (Basu, 2010) in India, barring a few pockets of very high HCV seroprevalence (Devi et al., 2004, Devi et al., 2005, Chelleng et al., 2008) the range is between 30% and 50% (Baveja et al., 2003, Sarkar et al., 2003, Sandesh et al., 2006, Saraswathi and Dutta, 2007, Mahanta et al., 2009) which is moderate in comparison to the 60–80% figures from many western countries. But in terms of sheer number, the magnitude of the problem is still appreciable and it may emerge as an epidemic if due considerations are not urgently undertaken. It is equally concerning to note a prevalence of 27% in the non-IDUs from Amritsar (Tiwari et al., 2006), which reinforces the notion that even non-IDUs are vulnerable to HCV infection through non-injecting routes (Neaigus et al., 2007).

Unfortunately, studies on risk behaviours that can be linked meaningfully to HCV infection are sparse. Available studies have identified sharing of drug use paraphernalia (Sarkar et al., 2006), and high-risk unprotected sex with multiple sex partners (Sarkar et al., 2006, Jindal et al., 2008) as risk behaviours. This has obvious implications for a culturally sensitive education and intervention.

It can be said that HCV infection in India is a major emerging problem and over the years, the major consequences of chronic HCV infection are likely to accumulate. We know that there is no HCV vaccine, and treatment is very expensive and has limited access. Therefore, the primary focus has to be on prevention. Research on HCV prevalence in IDU and especially other substance use is sparse. HCV infection seems to be more common in IDU than HBV and HIV infections (Solomon et al., 2008), again pointing towards the urgent need to prioritise this area. After HCV screening of blood products was made mandatory in India, IDU became the major route of HCV infection. It is also important to study the HCV seropositivity and risk behaviour profile in non-IDUs with other risk behaviour and compare these data with those of IDUs as well as non-IDUs without other risk behaviour.

Section snippets

Materials and methods

The study was carried out at a multispecialty tertiary care teaching hospital providing services to a large catchment area of north India. The study was carried out from 1st May 2008 to 30th April 2010. Institute Ethics Committee approved the project, and individual informed consent was obtained from the participants of the study.

The sample comprised of all the patients who were admitted in the Drug De-addiction and Treatment Centre (DDTC) ward during the study period. As a part of their

Results

All the subjects were males. Injecting drugs were used by 103 subjects (21.8% of the admitted patients whose records were available). Three hundred and sixty nine patients did not use any injecting drugs; out of these 124 indulged in one or more high risk behaviours and the remaining 245 did not indulge in any high risk behaviours.

The three groups were compared for age using one-way ANOVA and post hoc Tukey test. The non-IDUs without risk behaviour were the oldest (mean age 36.97 years, SD

Discussion

The seroprevalence of anti-HCV antibody in the current study (45.6%) is in accordance with the results of the earlier works in India. In view of large population of IDUs in India, this figure appears ominous. This finding reinforces the belief that there is urgent need to focus our attention on this menace. Only 5.1% among non-IDUs (with or without other HCV-related risk behaviour) were seropositive in our study. This was in sharp contrast with one study from India (Tiwari et al., 2006)

Funding

Partly funded by an Indian Council of Medical Research (ICMR) ad-hoc project titled “Hepatitis C Virus (HCV) infection: Prevalence, characterisation, and health-related risk behaviour in injecting drug users attending a de-addiction centre in northern India” (IRIS ID No. 2009-00660).

Conflict of interest

None.

References (14)

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