Hepatitis C virus infection epidemiology among people who inject drugs in europe: A systematic review of data for scaling up treatment and prevention

Lucas Wiessing, Marica Ferri, Bart Grady, Maria Kantzanou, Ida Sperle, Katelyn J. Cullen, Angelos Hatzakis, Maria Prins, Peter Vickerman, Jeffrey V. Lazarus, Vivian D. Hope, Catharina Matheï, Martin Busch, Kaat Bollaerts, Violeta Bogdanova, Elmira Nesheva, Nasia Fotsiou, Leontios Kostrikis, Viktor Mravčík, Vratislav ŘehákJitka Částková, Jiřina Hobstová, Blanka Nechanská, Jan Fouchard, Katri Abel-Ollo, Valentina Tefanova, Tatjana Tallo, Henrikki Brummer-Korvenkontio, Anne Claire Brisacier, Isabelle Michot, Marie Jauffret-Roustide, Ruth Zimmermann, Anastasios Fotiou, Gábor Gazdag, Anna Tarján, Brian Galvin, Lelia Thornton, Mario Cruciani, Monica Basso, Anda Karnite, Irma Caplinskiene, Sofia Lopes, Alain Origer, Jackie Melillo, Moses Camilleri, Carlo Olivari Demanuele, Esther Croes, Eline Op De Coul, Magdalena Rosińska, Marta Struzik, Mário Martins, Domingos Duran, Graça Vilar, Maria Emília Resende, Helena Cortes Martins, Adrian Octavian Abagiu, Simona Ruta, Victoria Arama, Boris Kopilovic, Tanja Kustec, Irena Klavs, Noelia Llorens Aleixandre, Cinta Folch, Maria Jose Bravo, Rosario Sendino Gómez, Torsten Berglund, Joakim Strandberg, Daphne Hotho, Sabine Van Houdt, Andrea Low, Bethan Mcdonald, Lucy Platt, Eleni Kalamara, Isabelle Giraudon, Teodora Groshkova, Claudia Palladino, Sharon Hutchinson, Fortune Ncube, Irina Eramova, David Goldberg, Julian Vicente, Paul Griffiths

    Research output: Contribution to journalReview articlepeer-review

    190 Citations (Scopus)


    Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. Methods and Findings: We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally 'difficult to treat' genotypes (G1+G4) showed large variation (median 53, IQR 43-62). Twelve countries reported on HCV chronicity (median 72, IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38-64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5-15). Burden of disease, where assessed, was high and will rise in the next decade. Conclusion: Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.

    Original languageEnglish
    Article numbere103345
    JournalPLoS ONE
    Issue number7
    Publication statusPublished - 28 Jul 2014

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