Can hepatitis C virus prevalence be used as a measure of injection-related human immunodeficiency virus risk in populations of injecting drug users? An ecological analysis

Addiction. 2010 Feb;105(2):311-8. doi: 10.1111/j.1360-0443.2009.02759.x. Epub 2009 Nov 16.


Background: Human immunodeficiency virus (HIV) outbreaks occur among injecting drug users (IDUs), but where HIV is low insight is required into the future risk of increased transmission. The relationship between hepatitis C virus (HCV) and HIV prevalence among IDUs is explored to determine whether HCV prevalence could indicate HIV risk.

Methods: Systematic review of IDU HIV/HCV prevalence data and regression analysis using weighted prevalence estimates and time-series data.

Results: HIV/HCV prevalence estimates were obtained for 343 regions. In regions other than South America/sub-Saharan Africa (SAm/SSA), mean IDU HIV prevalence is likely to be negligible if HCV prevalence is <30% (95% confidence interval 22-38%) but increases progressively with HCV prevalence thereafter [linearly (beta = 0.39 and R(2) = 0.67) or in proportion to cubed HCV prevalence (beta = 0.40 and R(2) = 0.67)]. In SAm/SSA, limited data suggest that mean HIV prevalence is proportional to HCV prevalence (beta = 0.84, R(2) = 0.99), but will be much greater than in non-SAm/SSA settings with no threshold HCV prevalence that corresponds to low HIV risk. At low HCV prevalences (<50%), time-series data suggest that any change in HIV prevalence over time is likely to be much smaller (<25%) than the change in HCV prevalence over the same time-period, but that this difference diminishes at higher HCV prevalences.

Conclusions: HCV prevalence could be an indicator of HIV risk among IDUs. In most settings, reducing HCV prevalence below a threshold (30%) would reduce substantially any HIV risk, and could provide a target for HIV prevention.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Confidence Intervals
  • Disease Outbreaks
  • HIV Infections / epidemiology*
  • HIV Infections / transmission
  • HIV-1*
  • Hepacivirus* / isolation & purification
  • Hepatitis C, Chronic / epidemiology*
  • Hepatitis C, Chronic / transmission
  • Humans
  • Prevalence
  • Risk Factors
  • South America / epidemiology
  • Substance Abuse, Intravenous / epidemiology*
  • Substance Abuse, Intravenous / virology