Prevalence of and trends in hepatitis C virus infection

Data on prevalence of infection with HCV are less readily available and, where provided, are subject to the same limitations as the HIV data. However, the overall picture is clear – HCV prevalence is extremely high in all countries and settings, with infection levels of between 40 % and 90 % among different countries and subgroups of IDUs (Figure 12).

Figure 12

Prevalence of hepatitis C virus infection among IDUs in the EU Member States

Figure 12

NB:

Figures in brackets are local data.

Differences between countries should be interpreted with caution because of different source types and use, in some cases, of local data or saliva tests, which underestimate prevalence. The colour for a country indicates the midpoint of the range of prevalence estimates obtained from different data sources.

This summary map is meant to give a global overview of HCV prevalence among IDUs in the EU. In this map data are reported for the most recent year available. Data from samples with no information on IDU status as well as self-reported test results were excluded. If this led to exclusion of sources that clearly improve generalisability (e.g. national data, out-of-treatment data) data from more than one year were combined. Data for Ireland and Luxembourg are limited to IDUs in prisons, while data for Italy are limited to HCV prevalence among IDUs in treatment and are not representative of HCV prevalence among IDUs who are not in treatment. Having health problems is one selection criterion for admission to drug treatment in some countries or cities (Greece, Portugal, Rome); because of long waiting lists or special programmes for infected IDUs, this may result in upward bias of prevalence. Prevalence in this map should not be compared with previous versions to follow changes over time, as inclusion of sources may vary according to data availability. For time trends, more methodological detail and for sources see Statistical Table 16 and Box 6 OL.

Source: Reitox national focal points. For primary sources see Statistical Table 16: Prevalence of hepatitis C infection among injecting drug users in the EU.

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Although all prevalence figures show very high levels of infection, the range is still wide. As for HIV, this may partly reflect different selection mechanisms in the different data sources, and comparisons should be made with caution. In 2000 and 2001, levels over 75 % were reported for Antwerp, Belgium (80 % of IDUs in drug-treatment and low-threshold services, 2001), Frankfurt and Berlin, Germany (82–90 % in a low-threshold service and two prisons), northern Greece and Greece at national level (83 % of IDUs in methadone-treatment programmes), the Italian regions of Piedmont, Trentino, Friuli-Venezia Giulia, Liguria, Emilia-Romagna, Basilicata and Sardinia and the cities of Trento and Bolzano (drug treatment), and in Lisbon and some smaller Portuguese cities (drug-treatment clients) (23).



As an indicator of high-risk injecting behaviour (e.g. sharing needles or other equipment) and the effectiveness of prevention programmes, trends in HCV prevalence may be much more sensitive than trends in HIV. HCV is more infectious than HIV and can be transmitted more easily through injecting materials other than syringes, such as cotton, spoons and water (but is very much less readily transmitted sexually). Both increases and decreases are found in different regions (24).

As far as they are available, data from treatment programmes indicate that the prevalence of HCV infection in IDUs aged under 25 varies from 12 % in Tampere, Finland (2001), to around 60 % in Dublin, Ireland (1997), and Italy (1999). Prevalence in young IDUs seems to be decreasing in Belgium and Greece but increasing in England and Wales (1998–2001).

Information regarding the prevalence of HCV infection in new injectors (those who have been injecting for less than two years) is still not available from most sources. Where data are available, they generally suggest that the prevalence is very high – 40 % or more – although lower figures have been reported from Belgium and the United Kingdom (Figure 13).


(23Box 5 OL: Trends in prevalence of hepatitis C.

(24) See Box 5 OL.