HIV Incidence Among People With HCV Who Use Drugs: an Opportunity for PrEP

Some people who inject drugs (PWID) remain at high risk of HIV acquisition. This despite available evidence-based harm reduction strategies, including syringe exchange, medication for opioid use disorder, and low-barrier treatment programs in some locations in the US. Researchers described the HIV incidence among people who use heroin and/or cocaine engaged in a mobile harm reduction clinic (n=260). All participants were HIV-negative at baseline and had at least one subsequent HIV test.

• Half of participants (55%) injected drugs and 33% were HCV infected at baseline.
• Over 331 person-years of risk, 10 participants (4%) became HIV-positive, conferring an HIV incidence of 3 per 100 person-years.
• Participants who acquired HIV were more likely to be HCV infection (80% versus 31%) and to report injection drug use (90% versus 52%) at baseline.
• In multivariate analyses adjusting for age, sex, nationality, receipt of methadone treatment, and injection use, baseline HCV status remained an independent predictor of time to HIV seroconversion (hazard ratio, 6.4).

Comments: HIV seroconversion in this cohort of people who used heroin and/or cocaine occurred in spite of access to harm reduction services. Baseline HCV infection emerged as an independent predictor of HIV seroconversion. HIV pre-exposure prophylaxis (PrEP) is an evidence-based strategy that reduces HIV acquisition among people with sexual and/or injection risk, but it has not been widely adopted for people who inject drugs. Study results suggest that HCV status may be one objective criteria that could be used to identify people who inject drugs who would benefit from intensified HIV prevention efforts like PrEP.

Jessica L. Taylor, MD

Reference: Valencia J, Ryan P, Alvaro-Meca A, et al. High HIV seroconversion rate in hepatitis C virus-infected drug users followed in a harm reduction unit: a lot opportunity for preexposure prophylaxis. AIDS. 2018; 32:9: 1157-1163.