Date Published: 17 October 2006
More injecting drug users have HIV, hepatitis B or hepatitis C now than in early 1990s (Eire)
The number of injecting drug users with HIV, hepatitis B or hepatitis C is higher in Ireland now than in early nineties according to a new report from the Health Research Board (HRB). Almost 70% of injecting drug users tested positive for antibodies to hepatitis C and 20% to hepatitis B. Almost 10% of injecting drug users are HIV-positive.
" It is well known that injectors have a higher risk of overdosing or acquiring blood-borne diseases like hepatitis C, hepatitis B and HIV," said Dr Jean Long, senior researcher in the Drug Misuse Research Division of the HRB.
" This highlights the importance of providing harm reduction facilities for those who continue to inject. The principles of expanded and accessible harm reduction measures are documented in both the AIDS Strategy 2000 and the Mid-Term Review of the National Drugs Strategy. These strategies will lead to actions to stem the current increase in new HIV cases among injecting drug users. It is anticipated that a hepatitis C strategy will be published soon by the Health Service Executive," she said.
Age, injecting practices and sexual practices are linked to HIV status. Older injectors are more likely to test positive than their younger counterparts. A longer history of injecting and a history of needle sharing is also associated with testing positive for HIV.
" Treatment for HIV is available to injecting drug users through genitor-urinary medical units and infectious disease clinics," explained Dr Long.
" However, research has shown that, while a number of injecting drug users were suitable for treatment they were not receiving it at that time. Two studies indicate that shared care between infectious disease units and specialised drug treatment centres achieved the best uptake and compliance with such treatment."
Hepatitis B status among treated users is also linked to age, injecting practices and sexual practices. The number of injecting drug users who started and completed a course of hepatitis B vaccine was higher in the HSE south-western area and in the Drug Treatment Centre Boards in the period 2001–2003 than in prisons or among those who attended GP clinics between 1998 and 2001. According to Dr Long, it is essential that the hepatitis B vaccine is administered as soon as possible in a drug user's career which indicates that needle exchanges, low-threshold methadone services and general practitioners need to have facilities to provide this intervention, free of charge, on a daily basis.
Hepatitis C is by far the most serious risk to injecting drug users. It is associated with injecting practices and with a prison history. The research shows low rates of access to and uptake of treatment for hepatitis C. Research also shows that, when general practitioners, drug treatment centres and hepatology centres take a more formal approach to treatment and follow-up, more people present for investigation.
Little data has been published in Ireland about co-infection with two or more of these viruses, or about viral infection combined with high alcohol consumption. Two prison studies in the late nineties showed that almost 20% of prisoners who tested positive for hepatitis C were also infected with hepatitis B or HIV.
" More up-to-date research is required on co-infection, as it is known that both HIV co-infection and independently, high rates of alcohol consumption among those infected with hepatitis C are associated with more rapid disease progression and higher death rates," said Dr Long.
" A major challenge is monitoring the number of newly diagnosed cases of infectious disease among injecting drug users. Newly diagnosed cases of HIV are reported directly to the Health Protection Surveillance Centre (HPSC), but until 2005 information on risk factors was not included in data recorded about hepatitis B and, to date, has not been recorded for hepatitis C. This makes it difficult to measure the trend in new cases of these diseases among injecting drug users; it also means that we are not in a position to report to the European Monitoring Centre for Drugs and Drug Addiction, which uses this information as one of the five indicators to measure the drug situation here."
The report recommends the following areas for future research and action:
- Quantify the success and effectiveness of current services provided specifically needle exchange, opiate detoxification and opiate maintenance programmes in stabilising and reducing the incidence of hepatitis C.
- Record risk factors associated with newly diagnosed cases of hepatitis C.
- Create a register to quantify the incidence and prevalence of hepatitis C among all heroin and cocaine users, and to facilitate assessment of the main risk factors, treatment uptake and outcomes.
- Adopt strategies to increase the uptake of and compliance with HIV and hepatitis C therapy in prisons and in community settings.
- Estimate the medical consequences of, and interventions required to deal with, hepatitis C among injecting drug users.
- Develop a system to monitor the uptake of hepatitis B vaccine among prisoners,
injecting drug users and sex workers.
Source: Health Research Board (Ireland).