Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention

Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. Methods and Findings: We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7–28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally ‘difficult to treat’ genotypes (G1+G4) showed large variation (median 53, IQR 43–62). Twelve countries reported on HCV chronicity (median 72, IQR 64–81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2–28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38–64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5–15). Burden of disease, where assessed, was high and will rise in the next decade. Conclusion: Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID

Fatal Opioid and Cocaine Related Overdoses: Prevention and Harm Reduction in the Light of Socioeconomic Inequality.

peer reviewedObjective. To explore socioeconomic inequalities in fatal overdose cases related to non-prescribed opioids’ and cocaine use. Methods. Overdose cases recorded in Luxembourg between 1994 and 2011 were individually matched with four controls, in a nested case-control study design, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs. 1,056 controls were analyzed. The study sample was stratified according to a Social Inequality Accumulation Score (SIAS), based on educational attainment, employment, income, financial situation and professional status of father or legal guardian of subjects. Least squares linear regression analysis on overdose mortality rates and ridit scores were applied to determine the Relative Index of Inequality (RII). Results. A negative linear relationship between the overdose mortality rate and the relative socioeconomic position was observed. We found a difference in mortality of 29.22 overdose deaths per 100 drug users between the lowest socioeconomic class compared to the most advantaged class. In terms of Relative Inequality Index, the overdose mortality rate of opioid and cocaine users with lowest socioeconomic profiles was 9.58 times as high as that of their peers from the highest socioeconomic class (95% CI ; 6.49 - 13.26).Conclusions. Our results suggest the existence of a social gradient in opioid and cocaine related overdose fatalities. Medical services, emergency and psychiatric wards should take due account of the socioeconomic situation of substance abusing patients and refer those at increased risk to socially supportive offers, thus contributing to reduce drug-related mortality