Transcript coinfection with hiv and hepatitis c virus among idus in north

COINFECTION WITH HIV AND
HEPATITIS C VIRUS AMONG IDUS IN
NORTH-EASTERN STATES OF INDIA
Santosh Kumar Sharma
International Institute for Population Sciences
Mumbai-400088
INTRODUCTION

Coinfection with HIV and hepatitis C virus (HCV) is a
significant problem, especially among injection drug
users (IDUs).

Hepatitis C virus (HCV) and human immunodeficiency
virus (HIV) are the two pathogens most commonly
transmitted by drug users through the multi-person use
(“sharing”) of drug injection equipment.

Hepatitis C virus infection is less known to public health
community than HIV in terms of health and social crisis,
but it is also concern. HCV is transmitted by exposure to
infected blood, and it is predominantly found in IDUs.
Cont.…
 Several studies have documented high prevalence of
infection with hepatitis C virus among injecting drug
users, both in industrialised and developing countries.

Moreover, co-infection with HCV and HIV is not
uncommon and has become a global public health
problem, causing an increased rate of progression to
cirrhosis, decompensated liver disease, hepatocellular
carcinoma, and death

Global estimates indicate that there are 15.9 million
(range 11.0-21.2 million) people who inject drugs (PWID)
across 151 countries
Cont…

In Southeast Asia, 70% to 86% of IDUs in the
Philippines, southern China and Thailand were infected
with HCV.

In India the prevalence of hepatitis C infection was very
high in Manipur (56% in Bishnupur and 78% in
Churachandpur), but lower in Nagaland (5.4% in Phek
and 16.7% in Wokha).

India is estimated to have 168,000 - 1.1 million IDUs with
HCV antibody prevalence ranging from 5 to 93 per cent
among HIV+ IDUs.
OBJECTIVES

To understand the risk factor associated with Co-infection
with HIV and Hepatitis C Virus among Injecting drug
users of North-East States of India
METHODS AND MATERIALS

A cross sectional bio-behavioural survey, Integrated
Behavioural and Biological Assessment round 2 (IBBA)
2010 data has been used to study the risk factor for
coinfection with HIV and HCV.

IBBA round 2survey collect the information among
Injecting drug users from Maharashtra (Mumbai/Thane
combined)
and
the
north-Eastern
states
(Churachandpur & Bishnupur from Manipur and Phek
& Wokha from Nagaland).
Integrated Behavioral and Biological Assessment: A Sexually
Transmitted and Blood-borne Infection Prevalence Assessment in
High Risk Populations in India
IBBA Round 2(2009-2010)
The sample size for Injecting drug users was 1650 and respondent driven
sampling was the method used to sample eligible respondents

IBBA populations
•Female Sex Workers Brothel Based (FSW-‐BB)
•Female Sex Workers Non-‐Brothel Based (FSW-‐NBB)
•Male Who Have Sex With Men (MSM)/Male Sex Workers (MSW)
•Male clients of Female Sex Workers
•Male Injecting Drug Users (IDU)
•Truckers Drivers and helper (TD/H)
•Female Sex Workers Highway-‐Based (FSW-‐HB)
National Highway
• Truckers Drivers and helper (TD/H)
• Female Sex Workers Highway-‐Based (FSW-‐HB)
In this study only IDUs of North-East states of Manipur
and Nagaland has taken. IDUs were selected on the
criteria of those who were 18 years or older, who
injected addictive substances/drugs for non-medical
purposes at least once in past six month
 A sample size of 400 was estimated for each survey
district. The sample size for Injecting drug users for
North-Eastern sates was 1650. As a result of the
clandestine nature of IDU, respondent driven sampling
(RDS), a social network-based sampling technique was
used.
 Chi square statistics and to identify the factor associated
with coinfection with HIV and HCV Binary logistics
regression was used to estimate odds ratios.

RESULTS AND DISCUSSION
 The prevalence of co-infection with HIV and HCV was
found 15 percent of Injecting drug users.
 HCV was present in 93% of HIV positive and 34.4% of HIV
negative IDUs.
 The prevalence of HIV in HCV positive and in HCV
negative was 34.3% and 1.7% respectively
 Overall HIV prevalence among Injecting drug users in
North-eastern states of India is 16 percent and HCV
prevalence is 44 %.
AGE(YEARS)
EDUCATION
MARITAL STATUS
1.9
11
OCCUPATION
OTHERS
11
STUDENT/UNEMPLOYED
9.1
SALARIED/SELFEMPLOYED/BUSINESSMAN
20
AGRICULTURE
WORKER
17
DIVORCED/SEPARATED/WIDOWED
21
MARRIED
12
UNMARRIED
13
11 YEARS AND ABOVE
6-10 YEARS
20
1-5 YEARS
ILLITERATE
25 AND ABOVE
18-24
Prevalence of coinfection with HIV and HCV by their
background Characteristics
39
35
28
21
Prevalence of co-infection with HIV and Hepatitis C
virus by their Injecting behaviour
25
16
10
20 OR
LESS®
12
12
21 - 25
18
17
26 AND
ABOVE
AGE AT FIRST DRUG USE(YEARS)
20 OR
LESS®
21 - 25
26 AND
ABOVE
AGE AT FIRST INJECTING
DRUGS(YEARS)
1.8
3.3
1OR
BELOW®
2-5
6 AND
ABOVE
DURATION BETWEEN FIRST DRUG
USE AND FIRST INJECTION
(YEARS)
Prevalence of co-infection with HIV and Hepatitis C
virus by their Injecting sharing behaviour
18
17
17
16
14
12
8.9
3.7
NO
YES
NO
YES
PARTNERS SHARED INJECTION WITH
NEEDLE/SYRINGE IN
PREFILLED
THE PAST MONTH
SYRINGE
NO
YES
NO
YES
DRAW UP DRUG
CLEANING OF
SOLUTIONS FROM A NEEDLE/SYRINGES
COMMON
CONTAINER
Factor associated with coinfection with HIV and
Hepatitis C virus

Older
IDUs,
6-10
years
of
schooling
and
divorced/separated/widowed are 14 times, 2.9 times and
3.6 times more likely to have co-infected with HIV and
HCV respectively

IDUs started drug use at the age of 26 and above are
2.28 times more likely to have co-infected with HIV and
HCV

One important finding of the study is those IDUs started
first injecting drug after 6 and above years of first drug
use, are approximately 4 times more likely to have Coinfection with HIV and HCV
Cont.…..

IDUs, co-infected with HIV and HCV are 1.7 times more
likely among those IDUs who draw up drug solutions from
a common container.

The behaviour of Cleaning needle/syringes by IDUs are
also 3 times more probable to co-infected with HIV and
HCV.
Summery of findings and Conclusions

The prevalence of Hepatitis C Virus is very high among
HIV seropositive Injecting drug users

Older IDUs and having less year of schooling are
significantly higher prevalence of coinfection with HIV and
HCV

One important finding is that widowed/divorced/separated
IDUs are more likely to co-infected with HIV and HCV

It was also found that those IDUs started drug use at the
age of 26 and above and longer duration between first
drug use to first injecting drugs are more probable to have
co-infected with HIV and HCV.
Cont.….

IDUs, co-infected with HIV and HCV are more likely
among those IDUs who draw up drug solutions from a
common container.

The behaviour of Cleaning needle/syringes by IDUs are
also 3 times more probable to co-infected with HIV and
HCV.

The study emphasize that there should be a preventive
strategies to control the coinfection with HIV and
hepatitis C infection among IDUs.

Services for drug users need to be improved and
increased, guided by harm reduction principles.
Hepatitis C prevention and access to hepatitis C
treatment is urgent.