Elsevier

Drug and Alcohol Dependence

Volume 61, Issue 3, 1 February 2001, Pages 211-215
Drug and Alcohol Dependence

Short communication
Hepatitis C disease among injection drug users: knowledge, perceived risk and willingness to receive treatment

https://doi.org/10.1016/S0376-8716(00)00144-7Get rights and content

Abstract

We surveyed 306 former injection drug users receiving methadone maintenance treatment in 1997–1998 in Providence, RI regarding, (1) knowledge of hepatitis C transmission; (2) the concordance of self-knowledge of hepatitis C virus (HCV) status versus actual status; (3) perceived risk of cirrhosis; and (4) willingness to receive therapy for hepatitis C. The seroprevalence of HCV was 87%. While 77% of participants knew that HCV could be sexually transmitted, 30% did not know that condoms are protective against transmission. Thirty of 45 persons who reported they were HCV seronegative were actually seropositive; 51 of 62 persons (82%) who reported they had never been HCV tested or did not know their HCV status were serologically HCV-positive. Over half of respondents (53%) would ‘definitely’ or ‘probably’ use interferon therapy for viral hepatitis when informed of the risks and benefits of treatment. We found significant gaps in knowledge about HCV among IDUs. Serologic confirmation of HCV status is important among drug users, as self-report of HCV infection is often unreliable. This population, with its high prevalence of HCV, may be interested in treatments that include interferon.

Introduction

Hepatitis C virus (HCV) is the most common chronic bloodborne infection in the United States (Centers for Disease Control and Prevention, 1998). An estimated 3.9 million persons, 1.8% of Americans, have been infected with HCV. Forty percent of chronic liver disease is HCV-related resulting in an estimated 8000–10 000 deaths annually (Centers for Disease Control and Prevention, 1998).

The prevalence of HCV is particularly high among injecting drug users, 50–95% in surveys worldwide (Alter, 1997). Injection drug use accounts for most HCV transmission in the USA. Hepatitis C is acquired more rapidly after initiating injection drug use than other viral infections (hepatitis B and HIV) (Villano et al., 1997). Rapid acquisition reflects cumulative exposure via drug equipment sharing with HCV-positive partners; sexual transmission is far less efficient (Garfein et al., 1996). Nevertheless, a description of drug users’ knowledge of HCV and their perceived risk of exposure via drug and sexual behaviors has not been detailed.

Chronic HCV develops in most (75–85%) persons after acute HCV infection (Di Bisceglie et al., 1991). Most studies have found that cirrhosis develops in 10–30% of persons with chronic HCV over a period of 20–30 years (Alter et al., 1992, Seeff et al., 1992, Tong et al., 1995). This finding often prompts the recommendation of antiviral therapy.

α Interferon was the first approved treatment for chronic HCV infection (Poynard et al., 1995). Interferon monotherapy, may slow the progression of liver disease; however, it is administered subcutaneously, a concern in treating drug injectors. Interferon often causes flu-like side effects (Poynard et al., 1995), nausea and muscle pain which may limit patient interest in its use. In addition, it has a limited sustained response, leading to the recent interest in combination therapies (Hoofnagle and Di Bisceglie, 1997).

Given the high prevalence of HCV among injection drug users, interferon treatment may be recommended to this population. The objectives of this study were to describe IDUs, (1) knowledge of hepatitis C disease transmission; (2) the concordance of self-knowledge of HCV status versus actual; (3) assessment of their perceived risk of cirrhosis if they were HCV-infected; and (4) willingness to receive interferon therapy for chronic HCV, given a list of specific burdens and benefits of this treatment.

Section snippets

Method

Between July 1997 and March 1998 we recruited a convenience sample of persons from the state's largest for-profit Methadone Maintenance Treatment Program (MMTP) for the Providence Methadone and Injection Use Study (PROMETHIUS), a study of health service utilization among injection drug users in Providence, RI (Clarke et al., 1999). To be eligible, MMTP clients had to have been continuously enrolled for at least 6 months, be over 18 years of age, nonpregnant, and to have signed informed consent

Results

During the recruitment period we enrolled 69% of eligible clients, based on review of the administrative database at MMTP. Eligible nonrespondents were not significantly different (P>0.10) from respondents in terms of gender and race. The 306 study participants were 56% male, 66% Caucasian, 18% African American, 11% Latino, and 39% married/cohabiting. Just over half (51%) were over 40-years-old, 39% had less than a high school education, 60% were unemployed and 39% had no medical insurance.

Discussion

While the epidemiology of HCV infection is well-described among injection drug users, their knowledge of the disease transmission, self-perceived risk of severe liver disease, and their willingness to receive the new treatments for hepatitis C such as interferon have received little attention. We found that in this population there are significant gaps in knowledge about hepatitis and its prevention, an overestimation of risk of disease progression, and a willingness to receive treatment

Acknowledgements

This study was supported by NIDA grant R01-DA-10567 and a grant from Roche laboratories.

References (18)

  • P.G. O'Connor et al.

    Human immunodeficiency virus infection in intravenous drug users: a model for primary care

    Am. J. Med.

    (1992)
  • M.J. Alter

    Epidemiology of hepatitis C

    Hepatology

    (1997)
  • M.J. Alter et al.

    The natural history of community-acquired hepatitis C in the United States

    New Engl. J. Med.

    (1992)
  • D. Best et al.

    Accuracy of perceptions of hepatitis B and C status: cross-sectional investigation of opiate addicts in treatment

    Br. Med. J.

    (1999)
  • Recommendations for prevention and control of hepatitis C virus (HCV) and infection and HCV-related chronic disease

    MMWR

    (1998)
  • J. Clarke et al.

    Victims as victimizers: physical aggression by persons with a history of childhood abuse

    Arch. Intern. Med.

    (1999)
  • N. Crofts et al.

    Methadone maintenance and hepatitis C virus infection among injecting drug users

    Addiction

    (1997)
  • A.M. Di Bisceglie et al.

    Long-term clinical and histopathological follow-up of chronic post-transfusion hepatitis

    Hepatology

    (1991)
  • M.I. Fingerhood et al.

    Prevalence of hepatitis C in a chemically dependent population

    Arch. Intern. Med.

    (1993)
There are more references available in the full text version of this article.

Cited by (148)

  • Opioid epidemic and liver disease

    2019, JHEP Reports
    Citation Excerpt :

    In 2005, a reported 53% of opioid treatment programmes offered on-site HCV testing, compared with only 34% in 2011.87 In addition, for patients not in opioid treatment programmes, the major limitation to risk factor-based screening is the high likelihood of misinformation or denial from the patient at the time of a clinical encounter and risk factor assessment.91–98 As a result of this and the changing epidemiology of HCV in the U.S., with an ever-increasing numbers of young patients, some have advocated for universal screening among adults, not limited only to those in the baby boomer birth cohort.99–101

  • ‘I didn't want to let it go too far.’ The decisions and experiences of people who inject drugs who received a liver disease assessment as part of a liver health promotion campaign: The LiveRLife study

    2017, International Journal of Drug Policy
    Citation Excerpt :

    Nonetheless, confusion regarding causes of advanced liver disease persisted despite this information being a focal point in the LiveRLife campaign. Study findings build on prior evidence of HCV and liver health knowledge among PWID (Doab, Treloar, & Dore, 2005; Stein, Maksad, & Clarke, 2001). Prior research, including LiveRLife survey results, has demonstrated a repeated misunderstanding of HCV test results among PWID (Doab et al., 2005; Marshall et al., 2015; O’Brien, Day, Black, & Dolan, 2008; Stein et al., 2001; Treloar et al., 2011).

View all citing articles on Scopus
View full text