Report higlights increase in HIV infections amongst IDUs in UK

New infections of HIV and hepatitis C virus increased amongst injecting drug users in the United Kingdom in 2004, according to a report issued by the Health Protection Agency. Evidence was also found of continuing hepatitis B virus infections amongst injecting drug users and hepatitis A infections.

Data collected by the Health Protection Agency and published in the report, Shooting Up: infections among injecting drug users in the United Kingdom, an update, October 2005 also revealed that up to 50% of injecting drug users with HIV are not aware that they are infected with the virus and that a significant minority of injecting drug users share needles, syringes and other injecting paraphernalia.

“The recent, and probably ongoing, increase in the prevalence of HIV infection among current injecting drug users is a cause for concern”, write the authors. For 2004, 118 new HIV infections have been reported where injecting drug use was the risk activity. Between 1998 and 2003 only 118 new infections in this risk group were reported. Although injecting drug users account for only 6% of the 70,000 cases of HIV seen in the UK, the report authors write, “The recent, and probably ongoing, increase in the prevalence of HIV infection among current injecting drug users is a cause for concern.”

Community surveillance projects involving over 2,500 injecting drug users found that only 37% had ever had an HIV test, and that of the individuals with HIV, only 50% were aware of their infection status.

The report found wide regional variations in the prevalence of HIV infection amongst injecting drug users in England. The highest prevalence was in London where 4% were infected with HIV. Elsewhere in England the prevalence of HIV infection was 1%.

Anonymous surveillance projects in 2004 found evidence of widespread injecting habits which involved a risk of infection with HIV or another blood-borne infection. A total of 28% of participants in the project said that they had shared needles or syringes in 2004 and 50% reported sharing other drug taking paraphernalia such as filters or spoons.

In 2004, the prevalence of hepatitis C infection amongst surveyed injecting drug users was 42%, similar to the 42% observed in 2003. An enhanced survey involving 952 injecting drug users found, however, that 54% were infected with hepatitis C virus, and that prevalence was highest (67%) amongst individuals with a history of crack-cocaine use.

Data were unavailable for hepatitis B virus infections in 2004 due to “a susbstantial deterioration in the quality of...reporting.” However, the investigators note that the prevalence of hepatitis B infections amongst injecting drug users participating in voluntary anonymous surveillance projects was 21%, similar to the level seen in 1995. Evidence of outbreaks of hepatitis A were also found amongst injecting drug users, which the report authors attribute to poor hygiene, oral-fecal contact during sex, or blood-borne transmission of the virus. Concern is expressed by the authors about continuing new infections with hepatitis A and B as effective vaccines against both viruses are available.

“The recent increase in infections amongst injecting drug users suggests a need to re-examine the nature and range of services provided”, conclude the investigators. They recommend that research should be conducted in order to provide services which “encourage and support hygienic injection practice.”