Gender Influences on Hepatitis C Incidence Among Street Youth in a Canadian Setting

PURPOSE: Few studies have examined gender-based differences in the risk of hepatitis C (HCV) infection among street-involved youth. We compared rates of HCV infection among male and female street-involved youth in a Canadian setting. METHODS: The At-Risk Youth Study (ARYS) is a prospective cohort of drug-using, street-involved youth. Study recruitment and follow-up occurred in Vancouver, Canada, between September 2005 and November 2011. Eligible participants were illicit drug-using youth aged 14–26 years at enrollment, recruited by street-based outreach. We evaluated rates of HCV antibody seroconversion, measured every six months during study follow-up, and used Cox proportional hazards regression to compare risk factors for HCV incidence between male and female street youth. RESULTS: Among 512 HCV-seronegative youth contributing 836 person-years of follow-up, 56 (10.9%) seroconverted to HCV. Among female participants, the incidence density of HCV infection was 10.9 per 100 person-years and in males 5.1 per 100 person-years (p = 0.009). In multivariate analyses, female gender was independently associated with a higher rate of HCV seroconversion (Adjusted Hazard Ratio (AHR) = 2.01; 95% Confidence Interval [CI], 1.18 – 3.44). Risk factors were similar in gender stratified analyses and included injection heroin and injection crystal methamphetamine, although syringe sharing was only associated with HCV incidence among males. CONCLUSIONS: Among street-involved youth in this setting, females had double the incidence of HCV seroconversion demonstrating the need for gender focused HCV prevention interventions for this population