Incarceration Increases HIV and Hepatitis C Risk Among Injection Drug Users

For people who inject drugs, recent incarceration is associated with considerable short-term increases in acquisition risk of hepatitis C virus (HCV) and HIV infection, and incarceration could therefore be a substantial driver of HIV and HCV transmission among PWID, according to a study published in The Lancet Infectious Diseases.

Incarceration is prevalent among people who inject drugs, and researchers in the current systematic review and meta-analysis assessed whether a history of incarceration elevates HCV or HIV acquisition risk in this population. Data were obtained through searches of Embase, MEDLINE, and PsycINFO databases for international studies concerning the incidence of HCV or HIV among people who inject drugs published from January 1, 2000 to June 13, 2017.

Studies that reported original results were included; those that evaluated self-reported incident infections were excluded. Random-effects meta-analyses to quantify associations between past or recent incarceration and HCV or HIV acquisition risk were used to extract and pool data from the studies. The Newcastle-Ottawa Scale was used to assess risk of bias.

Included for analysis were published findings from 20 international studies, as well as unpublished findings from 21 international studies. Past incarceration was associated with a 25% increase in risk of HIV acquisition (relative risk [RR], 1.25; 95% CI, 0.94-1.65) with moderate between-study heterogeneity (I²=49.8%; P =.025) and a 21% increase in risk of HCV acquisition (RR, 1.21; 95% CI, 1.02-1.43) with moderate between-study heterogeneity (I²=50.6%; P =.004).

Recent incarceration was associated with an 81% increase in risk of HIV acquisition (RR, 1.81; 95% CI, 1.40-2.34) with moderate between-study heterogeneity (I²=63.5%; P =.001) and a 62% increase in risk of HCV acquisition (RR, 1.62; 95% CI, 1.28-2.05) with moderate between-study heterogeneity (I²=57.3%; P =.002).

Study investigators concluded that the “findings add to the growing body of evidence for the harms associated with international drug policy, which result in many people who use drugs being incarcerated, and support calls for decriminalisation of illicit drug use and greater access to prison-based harm reduction, with linkage following release.” They go on to add that interventions to address the many social vulnerabilities people who inject drugs experience would be required to fully reduce risk.

Reference

Stone J, Fraser H, Lim AG, et al. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis [published online October 29, 2018]. Lancet Infect Dis. doi: 10.1016/S1473-3099(18)30469-9