1 Division of Viral Hepatitis, Centers for Disease Control and Prevention.
2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention.
3 Division of Allergy and Infectious Diseases, School of Medicine, University of Washington.
4 Denver Public Health, Denver Health and Hospital Authority.
5 STD/HIV Program, Louisiana Department of Health and Hospitals.
6 Chicago Department of Public Health.
7 Los Angeles County Department of Public Health.
8 Bureau of HIV/AIDS Epidemiology, New York State Department of Health.
9 TB/HIV/STD Branch, Texas Department of State Health Services.
10 Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
Historically, older people who inject drugs (PWID) have had the highest hepatitis C burden, however, young PWID account for recent increases in HCV infection. We assessed factors associated with past or present HCV infection (HCV antibody-positive) among young (≤35 years) and older PWID (>35 years).
Using Poisson regression, we calculated adjusted prevalence ratios (aPR) to examine socio-demographic and past 12-month injection risk behaviors associated with HCV infection.
Of 4,094 PWID, 55.2% were HCV antibody-positive (anti-HCV). Among young PWID, anti-HCV prevalence was 42.1% and associated with ≤high school diploma/GED (aPR=1.17, 95%CI=1.03-1.32), receptive syringe sharing (aPR=1.37, 95%CI=1.21-1.56), sharing injection equipment (aPR=1.16, 95%CI=1.01-1.35), arrest history (aPR=1.14, 95%CI=1.02-1.29), and injecting speedball (aPR=1.37, 95%CI=1.16-1.61). Among older PWID, anti-HCV prevalence was 62.2% and associated with ≤high school diploma/GED (aPR= 1.08, 95%CI=1.02-1.15), sharing injection equipment (aPR=1.08, 95% CI=1.02-1.15), high injection frequency (aPR=1.16, 95%CI=1.01-1.34), and injecting speedball (aPR=1.09, 95%CI=1.01-1.16).
Anti-HCV positivity prevalence is high and associated with risky injection practices. Almost half of young PWID were anti-HCV positive. Improving access to direct-acting antiviral treatment, syringe service programs, and medication-assisted therapy are critical to reducing HCV transmission risk and infection burden, particularly among young PWID who are more likely to be newly infected.