Pubdate: Thu, 21 Dec 2017
Source: Knoxville News-Sentinel (TN)
Copyright: 2017 The Knoxville News-Sentinel Co.


The United States' overall rate of hepatitis C infection more than
doubled from 2004 to 2014 -- and among people under 40, it increased
by 300 to 400 percent.

The reason for the jump? Transmission through injecting opioid drugs,
said a report published Thursday in the American Journal of Public

Lead author Jon Zibbell, senior public health analyst in the
Behavioral and Urban Health program of North Carolina-based RTI
International, said public health officials have long presumed the
link, but the research, performed in conjunction with a number of
other agencies, provides data to back it up.

Injection drug use is now the most common risk factor for hepatitis C,
itself the most common chronic bloodborne infection in the United
States, and data indicates 28 percent of injectors are infected within
a year.

"Once the virus is introduced into a network of persons who inject
drugs, it can circulate quickly through the reuse of contaminated drug
injection equipment -- specifically, needles, syringes, cookers and
filers," the report said.

Zibbell said that's accounted for hepatitis C outbreaks in various
parts of the country -- and public health experts expect more.

Zibbell, formerly with the Centers for Disease Control and Prevention,
had previously studied the relationship between hepatitis C infection
and drug injection in four states -- Tennessee, Virginia, West
Virginia and Kentucky -- and found a 200 to 300 percent increase in
the number of infected people who'd injected drugs.

"At the time, hepatitis C wasn't being talked about as part of the
opioid epidemic," Zibbell said, noting the absence of infectious
disease in the president's report on opioid addiction. "It was really
kind of a game changer."

Expanding the study model to look at all 50 states, "what we found
was, the same thing happened."

The study looks at infection rates among people admitted for substance
abuse treatment and found "statistically significant" increases of 400
percent among ages 18-29 and 300 percent among ages 30-39. At the same
time, the infection rate among people with risk factors other than
injected drug use didn't see the same increases.

Because hepatitis C infection doesn't always cause symptoms
immediately, and because such a small percentage of people addicted to
opioid drugs receive substance abuse treatment, both the number of
cases and the increase in them are likely much higher, Zibbell said.

The CDC estimates for every case of hepatitis C, another 33 go

The study showed the largest increases occurred east of the
Mississippi River and in central Appalachia -- including Tennessee.
Though men and women were infected, women were infected at a higher
rate. The study also found "statistically significant" increases in
hepatitis C infection among Hispanics, which Zibbell said could occur
as Hispanics "assimilate" into populations already using injectable
opioid drugs. In addition, in many urban areas, people of color are
statistically more likely to die of opioid overdose, he said.

"That was a real eye-opener for us," he said. "It can really speak to
the epidemic not just being a 'white' epidemic."

Hepatitis C, along with HIV and endocarditis -- infection of the
lining of the heart and its valves -- form a "big burden to the health
care system" in terms of cost and manpower, Zibbell said. HIV
outbreaks have been less common because of a lower prevalence of the
virus, he said, but have occurred -- such as last year in rural
Indiana -- and HIV patients, more and more, are infected with
hepatitis C also.

He hopes the report will help drive a national health response that
includes treating hepatitis C -- for which there is now a cure, albeit
an expensive one -- and HIV along with drug addiction. Treating
diseases independent of one another has been a "missed opportunity,"
he said.

Treating hepatitis C in people who spread the virus through injecting
drugs could have a significant public health impact, he said,
comparing the hepatitis C virus, which exists only in humans, to
smallpox: "We have a cure for hepatitis C. ... We could eliminate this
virus from the world."
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