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Global incidence of hepatitis C virus (HCV) and HIV infection among people who inject drugs: a systematic review and meta-analysis

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BACKGROUND: Data on the incidence of hepatitis C virus (HCV) and HIV infection among people who inject drugs (PWID) are key to informing prevention strategies. We conducted a systematic review and meta-analysis to synthesize global data on primary HCV and HIV incidence among PWID.
METHODS: We searched MEDLINE, Embase and PsycINFO for studies published between 01/01/2000 and 14/09/2020 that estimated HCV or HIV incidence among community-recruited PWID.We also contacted the authors of 35 studies to request updated or unpublished data. We included studies that estimated incidence by longitudinally re-testing people at-risk or by using tests for recent infection. We used random-effects meta-analysis to pool HCV and HIV incidence rates and the relative risks of HCV and HIV acquisition among women who inject drugs compared to men who inject drugs and young PWID (defined as <20 - '¤35) compared to PWID who were not young.
RESULTS: We retrieved 58 and 51 estimates for HCV and HIV incidence, derived from 25 and 24 countries, respectively. Globally, the pooled HCV incidence was 14.4 per 100 person-years (100py; 95% confidence interval (CI): 12.1-17.0, I2=96.2%) and the pooled HIV incidence was 1.6 per 100py (95%CI: 1.1-2.2, I2=98.2%) [Figure]. Relative to men, women had a higher risk of HCV and HIV acquisition [pooled relative risks: 1.20 (95%CI: 1.07-1.34; 32 estimates) and 1.30 (95%CI: 1.09-1.55; 25 estimates), respectively]. Relative to PWID who were not young, PWID who were had a higher risk of HCV and HIV acquisition [pooled relative risks: 1.32 (95%CI: 1.11-1.57; 24 estimates) and 1.42 (95%CI: 1.17-1.73; 21 estimates), respectively].


CONCLUSIONS: Findings indicate high HCV and HIV incidence among PWID, particularly among women and those who are young, emphasizing the importance of targeted prevention strategies. The limited data available in some regions indicate a pressing need to implement systems for monitoring HCV and HIV incidence in this population.