The Effect of Female Sex on Hepatitis C Incidence among People Who Inject Drugs: Results from the International Multicohort InC3 Collaborative

Aryan Esmaeili, Ali Mirzazadeh, Meghan D. Morris, Behzad Hajarizadeh, Henry S. Sacks, Lisa Maher, Jason Grebely, Arthur Y. Kim, Georg Lauer, Andrea Cox, Margaret Hellard, Paul Dietze, Julie Bruneau, Naglaa H. Shoukry, Gregory J. Dore, Andrew R. Lloyd, Maria Prins, Kimberly Page

Research output: Contribution to journalArticle

Abstract

The objective of this study was to assess differences in hepatitis C virus (HCV) incidence by sex in people who inject drugs (PWID), using a large international multicohort set of pooled biological and behavioral data from prospective observational studies of incident human immunodeficiency virus (HIV) and HCV infections in high-risk cohorts (the InC3 Collaborative). Methods. HCV infection date was estimated based on a hierarchy of successive serological (anti-HCV), virological (HCV RNA), and clinical (symptoms and/or liver function tests) data. We used a Cox proportional hazards model to calculate the crude and adjusted female to male (F:M) hazard ratio (HR) for HCV incidence using biological sex as the main exposure. Results. A total of 1868 PWID were observed over 3994 person-years of observation (PYO). Unadjusted F:M HR was 1.38 (95% confidence interval [CI], 1.15-1.65) and remained significant after adjusting for behavioral and demographic risk factors (1.39 [95% CI, 1.12-1.72]). Although syringe and equipment sharing were associated with the highest HCV incidence rate in women (41.62 and 36.83 PYO, respectively), we found no sex differences attributed to these risk factors. Conclusions. Our findings indicate that women who inject drugs may be at greater risk of HCV acquisition than men, independent of demographic characteristics and risk behaviors. Multiple factors, including biological (hormonal), social network, and differential access to prevention services, may contribute to increased HCV susceptibility in women who inject drugs.

Original languageEnglish (US)
Pages (from-to)20-28
Number of pages9
JournalClinical Infectious Diseases
Volume66
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Hepatitis C
Hepacivirus
Incidence
Pharmaceutical Preparations
Virus Diseases
Observation
Demography
Needle Sharing
Confidence Intervals
Liver Function Tests
Biological Factors
Risk-Taking
Proportional Hazards Models
Sex Characteristics
Social Support
Observational Studies
HIV
Prospective Studies
RNA
Equipment and Supplies

Keywords

  • hepatitis C virus
  • incidence
  • people who inject drugs
  • Sex
  • survival analysis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

The Effect of Female Sex on Hepatitis C Incidence among People Who Inject Drugs : Results from the International Multicohort InC3 Collaborative. / Esmaeili, Aryan; Mirzazadeh, Ali; Morris, Meghan D.; Hajarizadeh, Behzad; Sacks, Henry S.; Maher, Lisa; Grebely, Jason; Kim, Arthur Y.; Lauer, Georg; Cox, Andrea; Hellard, Margaret; Dietze, Paul; Bruneau, Julie; Shoukry, Naglaa H.; Dore, Gregory J.; Lloyd, Andrew R.; Prins, Maria; Page, Kimberly.

In: Clinical Infectious Diseases, Vol. 66, No. 1, 01.01.2018, p. 20-28.

Research output: Contribution to journalArticle

Esmaeili, A, Mirzazadeh, A, Morris, MD, Hajarizadeh, B, Sacks, HS, Maher, L, Grebely, J, Kim, AY, Lauer, G, Cox, A, Hellard, M, Dietze, P, Bruneau, J, Shoukry, NH, Dore, GJ, Lloyd, AR, Prins, M & Page, K 2018, 'The Effect of Female Sex on Hepatitis C Incidence among People Who Inject Drugs: Results from the International Multicohort InC3 Collaborative', Clinical Infectious Diseases, vol. 66, no. 1, pp. 20-28. https://doi.org/10.1093/cid/cix768
Esmaeili, Aryan ; Mirzazadeh, Ali ; Morris, Meghan D. ; Hajarizadeh, Behzad ; Sacks, Henry S. ; Maher, Lisa ; Grebely, Jason ; Kim, Arthur Y. ; Lauer, Georg ; Cox, Andrea ; Hellard, Margaret ; Dietze, Paul ; Bruneau, Julie ; Shoukry, Naglaa H. ; Dore, Gregory J. ; Lloyd, Andrew R. ; Prins, Maria ; Page, Kimberly. / The Effect of Female Sex on Hepatitis C Incidence among People Who Inject Drugs : Results from the International Multicohort InC3 Collaborative. In: Clinical Infectious Diseases. 2018 ; Vol. 66, No. 1. pp. 20-28.
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abstract = "The objective of this study was to assess differences in hepatitis C virus (HCV) incidence by sex in people who inject drugs (PWID), using a large international multicohort set of pooled biological and behavioral data from prospective observational studies of incident human immunodeficiency virus (HIV) and HCV infections in high-risk cohorts (the InC3 Collaborative). Methods. HCV infection date was estimated based on a hierarchy of successive serological (anti-HCV), virological (HCV RNA), and clinical (symptoms and/or liver function tests) data. We used a Cox proportional hazards model to calculate the crude and adjusted female to male (F:M) hazard ratio (HR) for HCV incidence using biological sex as the main exposure. Results. A total of 1868 PWID were observed over 3994 person-years of observation (PYO). Unadjusted F:M HR was 1.38 (95{\%} confidence interval [CI], 1.15-1.65) and remained significant after adjusting for behavioral and demographic risk factors (1.39 [95{\%} CI, 1.12-1.72]). Although syringe and equipment sharing were associated with the highest HCV incidence rate in women (41.62 and 36.83 PYO, respectively), we found no sex differences attributed to these risk factors. Conclusions. Our findings indicate that women who inject drugs may be at greater risk of HCV acquisition than men, independent of demographic characteristics and risk behaviors. Multiple factors, including biological (hormonal), social network, and differential access to prevention services, may contribute to increased HCV susceptibility in women who inject drugs.",
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