Knowledge of Positive HCV Status Does Not Decrease Risky Behaviors in People Who Inject Drugs

In this secondary analysis of data from a trial comparing strategies to increase HIV testing, researchers investigated the association between self-reported awareness of HCV infection status and injection-drug risk behaviors. Subjects included 1281 people enrolled in substance abuse treatment who reported either unknown or negative HIV status at baseline. The 244 subjects who also reported injection drug use in the past 6 months were included in this analysis.

• Ninety-two subjects (38%) reported being HCV positive, 55 (23%) reported being HCV negative, and 97 (40%) reported their HCV status was unknown.

• Compared with those whose HCV status was negative or unknown, subjects who reported being HCV positive were older, more likely to be women, more likely to be enrolled in opioid agonist treatment, and less likely to have been recently incarcerated.

• More than one-third of subjects (39%) reported recent syringe/needle sharing.

• In adjusted analyses, HCV-positive subjects were more likely to have shared syringes/needles than subjects whose HCV status was negative or unknown (adjusted odds ratio, 2.37).

Comments:

It is concerning that people who used injection drugs who knew they were HCV positive were more likely to engage in risky behaviors. It is likely that subjects who get tested and are infected with HCV engaged in more risky behaviors at baseline, and while they may well have reduced their risky behaviors after learning of their infection, they nevertheless have higher rates than those who are not infected or who do not know if they are infected. These results suggest that increased testing alone will not be sufficient to prevent new HCV infections.

Darius A. Rastegar, MD

Reference:

Korthuis PT, Feaster DJ, Gomez ZL, et al. Injection behaviors among injection drug users in treatment: the role of hepatitis C awareness. Addict Behav. 2012;37(4):552–555.