Combination of Substance Use Treatment and Risk Reduction Most Effective at Preventing HCV Seroconversion in People Who Inject Drugs

Prevention of hepatitis-C virus (HCV) seroconversion among people who inject drugs is a public-health priority because of the high prevalence of HCV infection in this population (40–90%), the likelihood of progression to chronic infection, and the probability that HCV-related mortality will surpass HIV-related mortality in the near future. This systematic review and meta-analysis sought to determine which risk-reduction interventions were most effective for reducing HCV seroconversion in people who inject drugs. Twenty-six studies met inclusion criteria: 4 randomized clinical trials and 22 observational studies. Intervention categories (which were not mutually exclusive) included behavioral intervention (2 studies); unspecified substance use treatment (5 studies); opioid replacement therapy (8 studies); syringe exchange (7 studies); syringe disinfection with bleach (4 studies); and multicomponent interventions, i.e., those that combined substance use treatment with either behavioral intervention or syringe exchange (2 studies).

• Multicomponent interventions reduced HCV seroconversion by 75%.

• The effects of single-component interventions were not significant.

Comments:

Although limited by lack of quality assessment and relatively few studies in the multicomponent intervention group, these data support the hypothesis that strategies combining substance-use treatment and risk reduction are most effective at prevention of HCV transmission in people who inject drugs.

Jeanette M. Tetrault, MD

Reference:

Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. 2011;204(1):74–83.