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Holly Hagan, Enrique R. Pouget, Richard S. Garfein, Reply to Gyarmathy, The Journal of Infectious Diseases, Volume 202, Issue 3, 1 August 2010, Pages 500–501, https://doi.org/10.1086/653841
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To the Editor—In her letter, Gyarmathy [1] suggested that our analysis of hepatitis C virus (HCV) seroconversion in injection drug users [2] may have failed to detect an association with syringe sharing because we did not account for the practice of cleaning used syringes with bleach. She cited data from her cross-sectional study of Hungarian injection drug users [3], in which prevalent HCV infection was associated with syringe sharing without first cleaning with disinfectant bleach during the 30 days prior to the study. Injection drug users in that study had been injecting drugs for 7.5 years, on average, so it is likely that the majority of HCV infections had occurred many years before the 30day referent period [3]. Indeed, one would not expect very recent behavior to reveal much about how these infections were acquired.
We conducted additional analyses and estimated the association between syringe sharing (with and without cleaning) and drug preparation equipment sharing in a model that adjusted for confounding. The results were unchanged. There were 4 fewer cases as a result of missing data on syringe cleaning with bleach. The odds ratio (OR) for the “shared and did not always clean” category was 0.87 (95% confidence interval [CI], 0.58–2.89), and the OR for the “shared but always cleaned” category was 1.14 (95% CI, 0.62–5.88). The OR for sharing preparation equipment remained significant (OR, 2.60 [95% CI, 1.02–22.74]). The new model did not explain significantly more variance than the old model by likelihood ratio test. Thus, we believe that our published results appropriately explain acquisition of HCV infection in this sample in relation to injection practices [2].
