Syringe exchange and risk of infection with hepatitis B and C viruses

The authors utilized a cohort study among Seattle injection drug users (IDU s) to assess whether participation in a syringe exchange program was associ ated with incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Susceptible IDU subjects (187 seronegative for antibody to HCV, and 460 seronegative for core antibody to HBV) were identified in drug trea tment, corrections, and social service agencies from June 1994 to January 1 996, and followed for seroconversion one year later. The subjects included in the analysis were Seattle-King County (Washington State) area IDUs enrol led in a larger multipurpose cohort study, the Risk Activity Variables, Epi demiology, and Network Study (RAVEN Study). There were 39 HCV infections (2 0.9/100/year) and 46 HBV infections (10.0/100/year). There was no apparent protective effect of syringe exchange against HBV (former exchange users, r elative risk (RR) = 0.68, 95% confidence interval (CI) 0.2-2.5; sporadic ex change users, RR = 2.4, 95% CI 0.9-6.5; regular users, RR = 1.81, 95% CI 0. 7-4.8; vs. RR = 1.0 for nonusers of the exchange; adjusted for daily drug i njection). Neither did the exchange protect against HCV infection (sporadic users, RR = 2.6, 95% CI 0.8-8.5; regular users, RR = 1.3, 95% CI 0.8-2.2; vs. RR = 1.0 for nonusers; adjusted for recent onset of injection and syrin ge sharing prior to enrollment). While it is possible that uncontrolled con founding or other bias obscured a true beneficial impact of exchange use, t hese data suggest that no such benefit occurred during the period of the st udy.