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High hepatitis C virus prevalence and incidence in a community cohort of young heroin injectors in a context of extensive harm reduction programmes
  1. Fernando Vallejo1,2,
  2. Gregorio Barrio3,
  3. M Teresa Brugal2,4,5,
  4. Jose Pulido1,2,
  5. Carlos Toro6,
  6. Luis Sordo1,2,
  7. Albert Espelt4,5,7,
  8. María J Bravo1,2,
  9. the Itinere Project Group
  1. 1National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
  2. 2Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain
  3. 3National School of Public Health, Carlos III Health Institute, Madrid, Spain
  4. 4Public Health Agency, Barcelona, Spain
  5. 5Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
  6. 6Service of Microbiology, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
  7. 7Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Spain
  1. Correspondence to Dr Gregorio Barrio, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Avda Monforte de Lemos, 5, Madrid 28029, Spain; gbarrio{at}


Background Cohort studies on hepatitis C virus (HCV) among drug injectors are scarcer than studies on HIV. Combined harm reduction interventions (HRIs) can prevent HCV infection. Spain has a medium–high coverage of HRIs.

Methods 513 young heroin users who injected drugs in the past 12 months (recent injectors) were street-recruited in 2001–2003 and followed until 2006 in three Spanish cities; 137 were anti-HCV seronegative, 77 of whom had ≥1 follow-up visit. Dried blood spots were tested for anti-HCV. HCV incidence and predictors of infection were estimated using Poisson models.

Results At baseline, 73% were anti-HCV positive. Overall incidence (n=77) of HCV seroconversion was 39.8/100 person-years (py) (95% CI 28.7 to 53.8). Excluding non-injectors during follow-up from the analysis (n=57), HCV incidence was 52.9/100 py (95% CI 37.4 to 72.5). Injecting at least weekly (incidence rate ratio (IRR)=5.2 (95% CI 2.5 to 11.1)) and having ≥2 sexual partners (IRR=2.2 (95% CI 1.1 to 4.7)) were independent predictors of HCV seroconversion; drug-injection history <2 years was marginally associated (IRR=2.4 (95% CI 0.9 to 4.7)). HCV incidence may have been underestimated due to differential attrition.

Conclusions Despite fairly high HRI coverage among Spanish drug injectors, a distressingly high incidence of HCV in a context of high HCV prevalence was found among young heroin injectors.


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