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Holly Hagan, Agent, Host, and Environment: Hepatitis C Virus in People Who Inject Drugs, The Journal of Infectious Diseases, Volume 204, Issue 12, 15 December 2011, Pages 1819–1821, https://doi.org/10.1093/infdis/jir654
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(See the article by Doerrbecker et al, on pages 1830–8, and the brief report by Thibault, on pages 1839–42.)
Hepatitis C virus (HCV) is hyperendemic worldwide in people who inject drugs (PWID) [1]. HCV prevalence rates in PWID typically vary between 40% and 90%, and incidences may fall between 20 and 40 infections per 100 person-years [2–6]. In high-income countries, half of PWID are infected with HCV within 5 years following onset of drug injection, and in low- and middle-income countries, half may be infected within 1 year [1]. A recent publication estimated that, globally, 10 million PWID have been infected with HCV [7].
Infectious disease control strategies typically target features of the agent, host, and environment to interrupt transmission; all such features of HCV favor rapid spread in PWID. The agent is highly efficiently transmitted via parenteral exposure to infectious blood, and it is relatively stable in the environment [8, 9]. Illicit drug injection practices may include the shared use of syringes and drug preparation equipment, such as drug cookers, filtration cotton, and rinse water; each of these host behaviors has been shown to be associated with HCV transmission [5, 6, 10]. Substantial declines in syringe sharing have dramatically reduced human immunodeficiency virus (HIV) incidence in PWID in high-income countries, but the shared use of other drug preparation materials persists [11, 12]; thus, HCV transmission continues at extremely high rates. Owing to HCV’s ability to evade the immune system, 70%–80% of infections become chronic [13, 14]. Thus, the environment—the settings in which PWID inject together—is characterized by a high prevalence of infectious carriers and a wide range of materials that may harbor and transmit HCV. In this issue of the Journal, 2 laboratory studies contribute new knowledge to our understanding of the mechanisms by which HCV may be transmitted among PWID via injection-related materials.
