NEWS: The Australian - 12/02/2007 'Sydney beats London in hep C stakes'

Sydney beats London in hep C stakes
By Tamara McLean
February 12, 2007

HEPATITIS C rates among young Sydney drug users are now among the highest in the world following the release of figures showing one in two contract the disease each year.
The city has outstripped London's alarming rates of infection, with the NSW research team warning that the “extremely high” numbers need the urgent attention of Australian policy makers.

“We obviously had an idea it was a problem but we had no idea it was going to be this high,” said Professor Lisa Maher from the National Centre in HIV Epidemiology and Clinical Research.

The team studied more than 200 addicts who were either younger than 30 or who had been injecting for less than three years, in Sydney's southwest.

They found that for every 100 new users followed for a year, 46 had the infection by the end.

Rates were highest among women, under 20-year olds, people originally from South East Asia, cocaine injectors and those who had been using for less than a year.

Prof Maher said these statistics, published in the Australian and New Zealand Journal of Public Health, and unpublished figures collected from two other NSW sites, painted a grim of rates in the state.

They exceed London which recently recorded a rate of 42 per 100 new users.

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Hepatitis C rampant in Sydney
Feb 12, 2007

"This one of the highest, if not the highest, documented rate of hep C infection in injecting-drug users in the world," Prof Maher said.

She said it shows prevention strategies implemented in the late 1980s don't appear to be working for this group.

New users appear to pick up the blood-borne disease almost immediately after they start injecting, making the window to help protect them "very, very small", she said.

"It seems you almost need to reach these people before they start injecting because otherwise they'll get the disease."

The findings also have implications for candidate vaccines currently in development.

"We'll need to be careful about who we immunise but obviously when is very important too," she said.

Hepatitis C is a slow-acting virus that causes liver inflammation and disease, as well as a range of symptoms like mood swings, itchy skin and nausea that can be managed with long-term treatment.

Professor Maher said female drug users were the most frequently infected because they were dependent on men to help them inject and were often relegated dangerous second use of the needle.

Cocaine injectors were more at risk than heroin addicts because they frequently "binged" in chaotic, risky situations where they did not have access to clean equipment.

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Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia

Authors: Maher, Lisa; Jalaludin, Bin1; Chant, Kerry G.1; Jayasuriya, Rohan2; Sladden, Tim3; Kaldor, John M.4; Sargent, Penny L.5

Source: Addiction, Volume 101, Number 10, October 2006, pp. 1499-1508 (10)

Abstract:
Aims 

To determine the incidence of hepatitis C virus (HCV) infection and identify risk factors for seroconversion. Design 

Prospective cohort study. Participants were recruited through direct approaches, street-based outreach, methadone and sexual health clinics and needle and syringe programmes. Setting 

Urban, regional and rural settings in New South Wales, Australia. Participants 

Injecting drug users (IDUs) (n = 584) were screened and tested for exposure to HCV. Between 1999 and 2002 antibody HCV negative IDUs (n = 368 ) were enrolled and followed-up every 3-6 months until seroconversion or study completion. Measurements 

Interviewer-administered baseline and follow-up questionnaires consisted of 131 items and included demographics, drug use and risk behaviour. Approximately 10 cc of whole blood was drawn at each visit. Specimens were stored at −70C and serology performed using one or two third-generation enzyme-linked immunosorbent assays and polymerase chain reaction testing. Findings 

Sixty-eight seroconversions were observed and incidence was 30.8 per 100 person-years, with incidence in IDUs injecting < 1 year, 133 per 100 person-years. Independent predictors of seroconversion were female gender, duration of injecting, injecting cocaine, shared use of filters and recruitment strategy. Conclusions 

Women, new initiates and IDUs recruited via outreach appear to be at increased risk of infection. Results confirm the significance of cocaine injection as a risk factor and provide the first evidence outside North America of the link between shared use of drug preparation equipment and incident HCV infection. Prevention efforts should attempt to raise awareness of the risks associated with drug sharing and, in particular, the role of potentially contaminated syringes in HCV infection.

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• HCVPWG Report 3 8 August 2006
  
• HCVPWG Powerpoint Slides 2006