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15 September 2006

Volume 194, Number 6
The Journal of Infectious Diseases 2006;194:764–772
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2006/19406-0007$15.00
DOI: 10.1086/505585
MAJOR ARTICLE

Social Structural and Behavioral Underpinnings of Hyperendemic Hepatitis C Virus Transmission in Drug Injectors

Devon D. Brewer,1

Holly Hagan,4

Daniel G. Sullivan,2

Stephen Q. Muth,5

Eileen S. Hough,3

Nathan A. Feuerborn,2 and

David R. Gretch2

1Interdisciplinary Scientific Research, 2Department of Laboratory Medicine, University of Washington, and 3Public Health–Seattle and King County, Seattle; 4Center for Drug Use and HIV Research and Institute for AIDS Research, National Development and Research Institutes, New York, New York; 5Quintus‐ential Solutions, Colorado Springs, Colorado

Background.Hepatitis C virus (HCV) is hyperendemic in drug injectors, yet social structural and behavioral factors underlying transmission are not well established.

Methods.We conducted a case‐control study of HCV seroconversion in drug injectors, focusing on transmission within networks. Incident case subjects ( ) and seronegative control subjects ( ) reported injection and sex partners and referred as many as 5 for interviewing and blood testing. We performed nucleotide sequencing of HCV isolates from infected individuals.

Results.Seventy‐eight percent of recent injection partnerships involved behavior that could transmit HCV. Case subjects and control subjects were similar demographically and behaviorally. Case subjects, however, had more HCV‐infected partners and consequently engaged in injection risk behavior with more infected partners. The injection network was mostly connected, dense, and cyclic, but the sexual network was highly fragmented. Although participants generally injected with partners of similar age, most HCV‐uninfected participants recently had injected with infected partners. In at least 1 of 4 pairs of genetically linked infections, transmission appeared to be due to sharing of injection equipment other than syringes. Except for transmission pairs, network distance between incident case subjects and genetic distance between their HCV variants were uncorrelated.

Conclusions.Without dramatic reductions in injection risk behaviors, shattering of cohesive injection networks, and/or broad coverage of an effective vaccine, HCV will likely remain hyperendemic in drug injectors.

Received 11 February 2006; accepted 9 March 2006; electronically published 17 August 2006.

Reprints or correspondence: Dr. Devon D. Brewer, Interdisciplinary Scientific Research, PO Box 15110, Seattle, WA 98115 (http://www.interscientific.net/contact.html).

Cited by

H. Hagan, E. R. Pouget, D. C. Des Jarlais, C. Lelutiu-Weinberger. (2008) Meta-Regression of Hepatitis C Virus Infection in Relation to Time Since Onset of Illicit Drug Injection: The Influence of Time and Place. American Journal of Epidemiology 168:10, 1099-1109
Online publication date: 9-Nov-2008.
CrossRef
Devon D Brewer, John J Potterat, Stephen Q Muth, David Gisselquist, Stuart Brody. (2008) Disconnects in presumed heterosexual HIV transmission in Malawi. AIDS 22:11, 1377
Online publication date: 1-Aug-2008.
CrossRef
Stuart Brody, Devon D Brewer, John J Potterat. (2007) Association of HIV Infection With Poor Genital Hygiene and Medical Treatment for Prior Serious Illness Suggests Iatrogenic Transmission. JAIDS Journal of Acquired Immune Deficiency Syndromes 44:3, 365-366
Online publication date: 1-Apr-2007.
CrossRef
Devon D. Brewer, Richard B. Rothenberg, John J. Potterat, Stephen Q. Muth. (2007) Data-Free Modeling of HIV Transmission in Sub-Saharan Africa. Sexually Transmitted Diseases 34:1, 54-56
Online publication date: 1-Feb-2007.
CrossRef

  • Presented in part: 25th International Sunbelt Social Networks Conference, Redondo Beach, CA, 16–20 February 2005; Workshop on Network Epidemiology, Stockholm, 7 November 2005.

    Potential conflicts of interest: none reported.

    Financial support: Association of Schools of Public Health (grant S425‐16/16); National Institute on Drug Abuse (grants DA08023, DA11447, and DA15026).

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