Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis
Andreea Adelina Artenie, Jack Stone, Hannah Fraser, Daniel Stewart, Chiedozie Arum, Aaron G. Lim, Anna McNaughton, Adam Trickey, Zoë Ward, Daniela Abramovitz, Michel Alary, Jacquie Astemborski, Julie Bruneau, Steven J. Clipman, Carla S. Coffin, Sara Croxford, Kora DeBeck, Eva Emanuel, Kanna Hayashi, Joumana Hermez, Daniel Low‐Beer, Niklas Luhmann, Gisela Macphail, Lisa Maher, Norah Palmateer, Eshan U. Patel, Rachel Sacks‐Davis, Wijnand van den Boom, Daniela K van Santen, Josephine G. Walker, Matthew Hickman, Peter Vickerman, Malvina Aladashvili, Tasnim Azim, Paul Dietze, Kostyantyn Dumchev, Jennifer R. Havens, Margaret Hellard, Sharon Hutchinson, Jennifer Iversen, Ali Judd, Martin Kåberg, Ann E. Kurth, Shruti H. Mehta, Viktor Mravčík, Maria Prins, Sunil S. Solomon, Steffanie A. Strathdee, Vana Sypsa, Catherine S. Todd, Jorge Valencia, Ernst Wisse
Abstract
BACKGROUND: Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. METHODS: In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. FINDINGS: =43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. INTERPRETATION: Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. FUNDING: Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.