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Risk factors and determinants of HIV and Hepatitis C prevalence and incidence among a cohort of young injection drug users

University of British Columbia

Objectives: The primary objectives of this study were to determine the prevalence, incidence and risk factors for HIV and Hepatitis C (HCV) infection among young (aged 13 - 24 years) injection drug users (IDUs) participating in the Vancouver Injection Drug Users Study (VIDUS). Methods: This study was a nested sub-study within the VIDUS project. The VIDUS is an open cohort consisting of over 1,400 Vancouver area IDUs. Participants must be aged 13 years and older, have injected illicit drugs at least once in the previous month and reside i n the greater Vancouver area. Enrolment into the study began in 1996, and the majority of participants were enrolled between 1996 and 1997. Since 1997, on average, 100 new study participants have been enrolled each year. At baseline and semi-annually thereafter, subjects undergo an interviewer-administered questionnaire and provide a venous blood sample for HIV and HCV antibody testing. Questionnaires are administered in English, Spanish, Mandarin, French and Cantonese and elicit information on participants' risk factors and living conditions in the previous six months. Nonparametric and multivariate regression methods were used when analyses were conducted on cross-sectional data. Longitudinal data were analyzed using person-time techniques. Results: Baseline HCV prevalence was 46% (107) and was associated with being Aboriginal, incarceration in the previous 6 months, survival sex, <100 lifetime partners, residence in the Downtown Eastside, and at least daily heroin, cocaine, or speedball injection. HCV seroconversion occurred among 37 of the youth, an incidence rate of 37.2 per person-years; the median age was 20 years and the median number of years injecting was 1.1. HCV seroconversion was independently associated with having an IDU partner and daily cocaine injection. Baseline HIV prevalence among the youth was 10% (23) and was independently associated with being female, daily cocaine injection, older age, and a greater number of years injecting. HIV seroconversion occurred among 16 youth, an incidence rate of 4.4 per person years; the median age was 22 and median number of years injecting was 3.0. HIV incidence was associated with being Aboriginal, at least daily crack or cocaine use, and <100 lifetime sexual partners. Conclusion: This sub-study was the first attempt to examine demographic characteristics and risk factors among young IDUs in a city coping with epidemic proportions of HCV and HIV among the IDU population. Young IDUs are of particular importance in terms of prevention of blood-borne infections. Relative to older IDUs, younger IDUs have lower prevalence of HIV and HCV but alarmingly high incidence rates, particularly among female and Aboriginal youth. The window of opportunity to act is short, and preventive actions are urgently required. This study has provided important clues where resources need to be targeted.

Thesis/Dissertation

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2009-09-28

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http://hdl.handle.net/2429/13272

Interdisciplinary Studies

University of British Columbia

UBCV

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