Hepatitis C at epidemic levels among young injectors in London

Levels of hepatitis C among young injecting drug users across London are reaching epidemic levels report researchers from Imperial College London, the Health Protection Agency and the London School of Hygiene and Tropical Medicine.

According to research published today in the British Medical Journal, four in ten new young injectors now has hepatitis C, while three per cent are now infected with HIV.

Hepatitis C, which can cause serious and sometimes fatal liver damage, is mainly spread by sharing needles and syringes. Preventing HCV transmission among injecting drug users is critical to avoiding significant later health consequences in the population and associated treatment costs.

Dr Ali Judd, from Imperial College London, based at Charing Cross Hospital, and one of the authors of the study, comments: “Hepatitis C is now spreading at epidemic levels across London and HIV incidence is worryingly high, which if unchecked will lead to an increase in the total number of HIV infections. There is an urgent need for new and comprehensive programmes to tackle this growing problem.”

For the study, the researchers recruited 428 injecting drug users, aged below 30 years or who had been injecting for six years or less, and followed them up one year later. The study was made possible through the use of saliva and blood spot tests for HCV and HIV developed at the Health Protection Agency Centre for Infections. Of those that were HCV negative or HIV negative at the first interview they found 42 percent and 3.4 percent were infected with HCV and HIV respectively one year later. The researchers also found high levels of syringe sharing, with one in four reporting injecting with needles and syringes that had been used by someone else in the last four weeks and one in two sharing other injecting paraphernalia.

Dr Matthew Hickman from Imperial College London, based at Charing Cross Hospital, and one of the authors of the study, comments: “For the past 6 or 7 years, government drug policy has focused on drugs and crime, and has been successful in expanding specialist drug treatment, especially through referral from criminal justice. However, there is a need now to re-invigorate harm reduction policies that prevent transmission of HCV and HIV.”

The researchers believe a number of factors may have contributed to the rise in the incidence of HCV and HIV. These include a rise in the number of injectors, without any increase in the number of syringes distributed through syringe programmes, more risky injecting behaviour in newer injecting drug users, and greater levels of crack injection. There has also been a lack of targeted health promotion campaigns about hepatitis C in recent years.

The study was funded by the Policy Research Programme of the Department of Health.