Incidence and Risk Factors for Hepatitis C Virus Infection among Illicit Drug Users in Italy

Enea Spada, Giovanni Rezza, Anna Rosa Garbuglia, Flavia Lucia Lombardo, Ornella Zuccaro, Francesca Menniti Ippolito, Elisabetta Cupellaro, Stefania Capone, Maria Rosaria Capobianchi, Alfredo Nicosia, Riccardo Cortese, Antonella Folgori, Alfonso Mele, Carlo de Mei, Angela Coia, Vittorio Santi, Marco Masci, Anna Maria Cioce, Vincenzo Mellace, Egidio BattagliaFranco Montesano, Vincenzo Biancolilli, Pasquale Farina, Marco Cuccuini, Giuliano Dozzini, Antonio de Luna, Raffaele Lovaste, Silvana Chiasera, Antonia Cinquegrana, Enrico Elba, Elisabetta Secchi, Umberto Nizzoli, Angela Zannini, Henri Margaron, Lucia Mancino, Salvatore de Masi, Salvatore Lobello, Andrea Vendramin, The Collaborative Study Group

Research output: Contribution to journalArticlepeer-review


So far, only three small outdated studies have investigated hepatitis C virus (HCV) incidence and risk factors among illicit drug users (DUs) in Italy. Thus, during 2007–2010, we conducted a prospective cohort study among DUs attending 17 Italian rehabilitation centers serving urban areas. Two hundred eighty-four HCV-uninfected DUs were prospectively followed by interview and anti-HCV antibody and RNA testing every 6 months. Incidence was calculated using the person-years method. Infection predictors were assessed by time-dependent Cox analysis. Participants were mostly male (83.4%), under opioid substitution therapy (OST) (78.9%), non-injecting DUs (67.9%), and with a mean age of 30.8. Ninety-one of 224 DUs initially under OST interrupted treatment during the follow-up. Overall HCV incidence was 5.83/100 person-years at risk (PYAR) [95% confidence intervals (CI), 3.63–9.38]. The incidence did not significantly differ according the participants’ sociodemographic characteristics or the degree of urbanization of the towns involved in the study. The incidence was higher for DUs under than for those not under OST (6.23 vs 4.50/100 PYAR; p = 0.681). Incidence was also higher for those with than for those without OST interruption (7.17 vs 5.04/100 PYAR; p = 0.55). However, all these differences were non-significant. At last follow-up visit, a significant decrease in frequency of sharing equipment for preparation/using drugs (by injection or not) was observed by analyzing either the whole cohort or DUs under OST only. Anti-HCV seroconversion resulted independently associated with sharing drug preparation/use equipment, backloading, having a HCV-positive sexual partner, or household and (marginally) intravenous injection. In this study, HCV incidence was non-negligible and OST seemed to lack effectiveness in reducing it. In Italy, implementation of combined harm reduction interventions and antiviral treatment of chronically infected DUs would be needed.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalJournal of Urban Health
Publication statusAccepted/In press - Dec 4 2017


  • Hepatitis C virus
  • Illicit drug use
  • Incidence
  • Opioid substitution treatment
  • Risk factors
  • Seroconversion

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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