1. Injection Drug Use (IDU) Paraphernalia and Hepatitis B and C Infection Associations in
a Cohort of Puerto Rican IDUs in Miami, Florida
Arturo E. Rodríguez, PhD(c), MPH
Claremont Graduate University
Introduction
References(selected)
Methods
ConclusionResults
Hepatitis infections are quite prevalent in
injection drug users (IDUs). Prevalence rates of
hepatitis B (HBV) and hepatitis c (HCV) in the
IDU population can be as high as 80%. The
problem is exacerbated when individuals are
co-infected with the HIV virus. Due to the
absence of clinical symptoms, IDUs can be
infected for years before they are diagnosed.
During that time, they are likely to engage in
risky injection and sexual behaviors that spread
the disease to others.
Hispanic/Latino IDUs are especially at risk for
HBV/HCV infection. Hispanics/Latinos with
HBV and/or HCV have been shown to have
higher alanine transaminase, aspartate
transaminase, and bilirubin enzymes as
compared to other racial/ethnic groups.
HBV/HCV infected Hispanics/Latinos have also
been shown to progress faster with liver fibrosis
than African Americans or whites.
IDU paraphernalia and its role in the
transmission of HBV/HCV continues to be an
important, yet less researched area. This study
aims at identifying the risks for HBV and HCV
infection associated with sharing of IDU
paraphernalia in a cohort of Puerto Rican IDUs
in Miami, Florida.
Along with reusing dirty needles, other shared
IDU paraphernalia, in this case cookers, were
found to be associated with HBV infection in
this cohort. With regards to HCV, only reusing
needles was found to be significantly
associated with HCV infection.
This study looks at whether HBV and HCV
infections could be attributed to shared IDU
paraphernalia in a cohort of Hispanic/Latino
IDUs, in this case, Puerto Ricans exclusively.
This study is also the first in a series that will
look at whether different Hispanic/Latino
ethnic groups respond differently given the
same risk factors for HBV and HCV infection
Further research is needed in order to
understand these different risk patterns in
specific Hispanic/Latino subgroups.
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This study utilizes data taken from an original
CDC-funded study (U65/CCU423371)
Participants (n=160) were selected based on
their self identification of Puerto Rican descent.
All participants were at least 18 years of age or
older and current IDUs. The outcome variables
were positive HBV or HCV infection as
confirmed by lab testing. The shared IDU
paraphernalia included: cookers, cottons, rinse
water, and needles. In addition, data on
backloading (using one syringe to prepare the
drug and distribute preparation to other
syringes) was also included in the analyses.
Data were analyzed utilizing logistic regression.
Unadjusted (OR) and adjusted (AOR) odds
ratios were obtained along with corresponding
95% confidence intervals.
Table 1
Demographic Characteristics of Participants
N (%)
Gender
Male
Female
141 (88.1)
19 (11.9)
HBV Serostatus
Positive
Negative
107 (66.9)
53 (33.1)
HCV Serostatus
Positive
Negative
135 (84.3)
25 (15.7)
Age
18-29
30-39
40-49
50 and older
49 (30.6)
66 (41.3)
29 (18.1)
16 (10.0)
Education
HS/GED degree
No HS/GED
67 (41.9)
93 (58.1)
Marital Status
Married/Living with partner
Single/Separated/Divorced
19 (11.9)
141 (88.1)
Residence
Own house / family / friends
Boarding house/Shelter/Street
72 (45.0)
88 (55.0)
Employment
Employed
Unemployed
29 (18.1)
131 (81.9)
Income
None
< $5,000
$5,000-$9,999
$10,000-$14,999
$15,000-$19,999
$20,000 or more
64 (40.0)
30 (18.8)
22 (13.8)
15 (9.4)
13 (8.1)
16 (10.0)
Table 2
Adjusted Odds Ratios (AOR) for HBV Infection by IDU Paraphernalia/Behavior
N (%) AOR 95% CI (p-value)
Use a dirty cooker
Less than and up to half the
time
More than half of the time
67 (41.9)
93 (58.1)
1.000
3.365 1.042-10.867 (0.043)
Use a dirty cotton
Less than and up to half the
time
More than half of the time
92 (57.5)
68 (42.5)
1.000
0.720 0.210-2.475 (0.602)
Use dirty rinse water
Less than and up to half the
time
More than half of the time
98 (61.3)
62 (38.7)
1.000
0.626 0.214-1.832 (0.393)
Engage in backloading
Never
At least sometimes
66 (41.3)
94 (58.7)
1.000
0.603 0.250-1.452 (0.259)
Use dirty needles
Never
At least sometimes
64 (40.0)
96 (60.0)
1.000
2.584 1.070-6.241 (0.035)Table 3
Adjusted Odds Ratios (AOR) for HCV Infection by IDU Paraphernalia/Behavior
N (%) AOR 95% CI (p-value)
Use a dirty cooker
Less than and up to half the
time
More than half of the time
67 (41.9)
93 (58.1)
1.000
1.684 0.472-6.002 (0.422)
Use a dirty cotton
Less than and up to half the
time
More than half of the time
92 (57.5)
68 (42.5)
1.000
1.094 0.238-5.020 (0.908)
Use dirty rinse water
Less than and up to half the
time
More than half of the time
98 (61.3)
62 (38.7)
1.000
1.101 0.269-4.503 (0.893)
Engage in backloading
Never
At least sometimes
66 (41.3)
94 (58.7)
1.000
1.440 0.540-3.839 (0.466)
Use dirty needles
Never
At least sometimes
64 (40.0)
96 (60.0)
1.000
4.447 1.593-12.415 (0.004)
Acknowledgements
Many thanks to Claremont Graduate University, Office of the Sr. VP of Finance and Admin.; Dr. Jessy G. Dévieux, Florida International University; Dr.
Jesús Sánchez, Nova Southeastern University