Role of HCV Viremia in Corroborated HCV Transmission Events Within Young Adult Injecting Partnerships.

BACKGROUND: Hepatitis C virus (HCV), a major cause of morbidity and mortality, is common and rising among young persons who inject drugs (PWID). Reducing the level of viremia may be an intervention, yet the impact of viremia on HCV transmission is unknown. METHODS: We conducted a prospective study of injecting partnerships (Partner Study) of young adult (age < 30 years) PWID within the UFO Study, which enrolled those at risk for HCV or with seronegative viremic infection and up to 3 HCV RNA-positive regular injecting partners. We examined the level of HCV viremia and stage of infection in the HCV-positive partner in regression analyses of HCV transmission events that were corroborated via HCV phylogenetic linkage analyses. RESULTS: We enrolled 69 at-risk/acutely infected PWID. There were 25 new HCV infections (incidence rate, 35.9 per 100 person-years; 95% confidence interval [CI], 24.3-53.2 per 100 person-years); 12/25 (48%) were phylogenetically linked to at least 1 partner. We found no association between the infected partner's quantitative level of HCV viremia and likely transmission in multivariate analyses (adjusted odds ratio [AOR], 0.90; 95% confidence interval [CI], 0.55-1.46); however, seronegative viremic infection in the infected partner was associated with increased transmission (AOR, 28.02; 95% CI, 5.61-139.95). CONCLUSIONS: The HCV viremia level was not associated with increased odds of transmission, yet acute HCV infection (seronegative viremic) was. Explanations include high-risk behavior during acute infection or missed fluctuations in viremia during acute infection. Both point to the need for frequent testing to detect new infection and attempt to prevent onward transmission

Treatment cascade for hepatitis C virus in young adult people who inject drugs in San Francisco: Low number treated.

OBJECTIVE:To understand the number of young adult people who inject drugs (PWID) with hepatitis C virus (HCV) infection accessing direct-acting antiviral (DAA) treatment and their barriers and facilitators to treatment uptake. METHODS:Using prospective cohort data from young adult PWID in San Francisco with newly identified HCV infection, we calculated the number who: (i) accepted referral to DAA therapy, (ii) initiated DAA therapy, (iii) completed DAA therapy, and (iv) achieved sustained virologic response (SVR) or cure. Behavioral survey data identified possible barriers and facilitators to DAA therapy. RESULTS:Of 60 young adult PWID with new HCV infection identified between February 2015 and January 2018, thirty accepted a referral to HCV care; five initiated and completed HCV treatment and achieved cure. Barriers to DAA uptake included fear of medical establishments, competing basic needs, and delaying care because they were feeling well. CONCLUSION:While few HCV-positive young adult PWID engaged in DAA therapy, all those who did achieved cure. Youth-tailored services that overcome the stigma and marginalization related to injection drug use are needed to improve treatment uptake

A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners

BackgroundTo date, research applying the Sexual Relationship Power Scale (SRPS) has been limited to sexual risk behaviors.ObjectiveWe measured levels of sexual relationship power and examined associations between sexual relationship power and injecting and sexual behaviors that place women at increased risk for blood borne infections.MethodsUsing data from a cross-sectional study of young women who inject drugs (WWID) in San Francisco, USA, logistic regression analysis identified independent associations between SRPS and subscale scores (relationship control [RC] and decision making dominance [DMD]) and injecting and sexual behaviors.ResultsOf the 68 young WWID, 24 (34%) reported receptive syringe sharing, 38 (56%) reused/shared a cooker to prepare drugs, and 25 (37%) injected someone else's drug residue during the three-months prior to enrollment. Most (60, 88%) reported condomless sex with main sex-partner, 8 (12%) reported transactional sex, and 36 (53%) had two or more recent sex partners. The median SRPS score was 2.98 (IQR: 2.65, 3.18), 3.23 (IQR: 3.23, 3.57) for RC and 2.40 (IQR: 2.20, 2.60) for DMD. No significant associations were detected between SRPS or DMD and injecting or sexual risk behaviors. After adjusting for gender and years injecting, for every one-point increase in RC, women had a 6.70 lower odds of recent condomless sex (95%CI: 0.92, 50.00, p = 0.06), and a 3.90 lower odds of recent transactional sex (95%CI: 1.22, 12.50, p = 0.02).ConclusionOur study findings suggest that some components of sexual relationship power may play a role in sexual risk, but not in injecting risk

A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs.

ObjectivesTo determine the association between multiple drug use and nonfatal overdose among young people (younger than 30 years) who inject drugs.MethodsWe completed a longitudinal study of 173 injection drug users younger than 30 years living in San Francisco, California, between April 2012 and February 2014.ResultsThe odds of nonfatal overdose increased significantly as heroin and benzodiazepine pill-taking days increased and when alcohol consumption exceeded 10 drinks per day compared with 0 drinks per day.ConclusionsHeroin, benzodiazepine, and alcohol use were independently associated with nonfatal overdose over time among young people who inject drugs. Efforts to address multiple central nervous system depressant use remain an important component of a comprehensive approach to overdose, particularly among young people

A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs

Objectives. To determine the association between multiple drug use and nonfatal overdose among young people (younger than 30 years) who inject drugs. Methods. We completed a longitudinal study of 173 injection drug users younger than 30 years living in San Francisco, California, between April 2012 and February 2014. Results. The odds of nonfatal overdose increased significantly as heroin and benzodiazepine pill-taking days increased and when alcohol consumption exceeded 10 drinks per day compared with 0 drinks per day. Conclusions. Heroin, benzodiazepine, and alcohol use were independently associated with nonfatal overdose over time among young people who inject drugs. Efforts to address multiple central nervous system depressant use remain an important component of a comprehensive approach to overdose, particularly among young people

Flow chart of total study population and analytic sample.

<p>Flow chart of total study population and analytic sample.</p

Characteristics of the HCV-negative “at-risk” injection partner at enrollment (n = 50)^‡.

‡<p>Data represent unique injection partners as individuals could enroll with multiple injection partners.</p>†<p>Prior 3-months.</p>††<p>Age <30 when enrolled in parent study; a small number of participants were age >30 at enrollment in partner study.</p><p>Characteristics of the HCV-negative “at-risk” injection partner at enrollment (n = 50)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109282#nt101" target="_blank">‡</a>}.</p

Bivariate associations for characteristics associated with recent receptive syringe and cooker use.

<p>Note: Data from 345 HCV-negative observations representing 70 unique partnerships followed monthly for 6-months or until inactive.</p>†<p>prior 30 days.</p><p>*p≤0.10.</p><p>**p≤0.05.</p><p>***<0.001.</p><p>Bivariate associations for characteristics associated with recent receptive syringe and cooker use.</p

Multi-level multivariate models for recent high rink injecting behaviors.

<p>Note: Data from 345 HCV-negative observations representing 70 unique partnerships followed monthly for 6-months or until inactive.</p><p>GEE models with link logit, controlling for multiple partnerships.</p><p>ARR = Adjusted Risk Ratio.</p>†<p>Prior month.</p><p>*p≤0.10.</p><p>**p≤0.05.</p><p>***p≤0.001.</p><p>Multi-level multivariate models for recent high rink injecting behaviors.</p

Injection partnership-level characteristics and behaviors at enrollment, reported by the at-risk HCV-negative partner (n = 70).

†<p>within the prior 30 days.</p><p>Injection partnership-level characteristics and behaviors at enrollment, reported by the at-risk HCV-negative partner (n = 70).</p