Injection drug use is the primary mode of transmission for hepatitis C virus (HCV) infection^1,2 and accounts for at least half of all documented new infections, a figure that is likely a significant underestimate.^1,3,4 Hepatitis C virus infection is endemic among persons who inject drugs, with most estimates of prevalence ranging from 60% to 90%.⁵ Although newer medications for HCV offer the potential for cure with fewer adverse effects, treatment will come at great financial cost. Furthermore, major barriers to HCV treatment for injection drug users exist and will not be easily overcome.⁶ Therefore, a critical need for interventions that can prevent new HCV infections in this group remains. Providing maintenance opioid agonist therapy with methadone hydrochloride or buprenorphine hydrochloride for opioid use disorders is one strategy for reducing injection drug use and the spread of HCV. Maintenance opioid agonist therapy may facilitate injection cessation and thus reduce the risk for HCV acquisition⁷; however, treatment adherence can fluctuate among users, and not all treatment programs require complete abstinence. Two studies, a meta-analysis⁸ and a pooled analysis study,⁹ reported reduced HCV incidence in association with opioid agonist therapy, with reductions ranging from 40% to 60%. However, many of the studies in both analyses^8,9 were conducted in populations of older adults and prisoners; also, most predated the use of buprenorphine.

An estimated 3 million Americans have been exposed to the hepatitis C virus (HCV), representing approximately 1.6% of the US population.¹ Although the primary burden of disease associated with HCV is liver related, other organ systems may be involved.^2,3 Chronic HCV has been linked to several different forms of glomerulonephritis and to albuminuria.^4-16 However, to date no large-scale longitudinal studies (to our knowledge) have quantified the risk for clinically significant renal outcomes among individuals with HCV compared with uninfected control subjects. We used data from Medicare, the Department of Veterans Affairs (VA), and the United States Renal Data System (USRDS) to determine whether seropositivity for HCV was associated with an increased risk for developing treated end-stage renal disease (ESRD).

This study examined associations between mortality and demographic and risk characteristics among young injection drug users in San Francisco, California, and compared the mortality rate with that of the population. A total of 644 young (<30 years) injection drug users completed a baseline interview and were enrolled in a prospective cohort study, known as the UFO (“U Find Out”) Study, from November 1997 to December 2007. Using the National Death Index, the authors identified 38 deaths over 4,167 person-years of follow-up, yielding a mortality rate of 9.1 (95% confidence interval: 6.6, 12.5) per 1,000 person-years. This mortality rate was 10 times that of the general population. The leading causes of death were overdose (57.9%), self-inflicted injury (13.2%), trauma/accidents (10.5%), and injection drug user-related medical conditions (13.1%). Mortality incidence was significantly higher among those who reported injecting heroin most days in the past month (adjusted hazard ratio = 5.8, 95% confidence interval: 1.4, 24.3). The leading cause of death in this group was overdose, and primary use of heroin was the only significant risk factor for death observed in the study. These findings highlight the continued need for public health interventions that address the risk of overdose in this population in order to reduce premature deaths.

Previous research supports an association between hepatitis C virus (HCV) infection and glomerulonephritis. However, little is known about the association between HCV and chronic kidney disease. The cross-sectional association between prevalent hepatitis C seropositivity and albuminuria and estimated GFR (eGFR), respectively, was examined among 15,029 participants in the Third National Health and Nutrition Examination Survey (NHANES III). In the multivariate analysis, we noted an age-dependent association between HCV seropositivity and albuminuria (adjusted odds ratios and 95% confidence intervals 0.83, 0.39 to 1.75 for ages 20 to 39; 1.84, 1.00 to 3.37 for ages 40 to 59; 2.47, 1.27 to 4.80 for ≥60 yr of age). There was no significant association observed for hepatitis C seropositivity and low eGFR (<60 ml/min per 1.73 m²; adjusted odds ratios and 95% confidence interval for all ages 0.89, 0.49 to 1.62). Among a representative sample of the US population, hepatitis C is independently associated with albuminuria among adults over the age of 40; however, it does not seem to be significantly associated with a low eGFR in this population-based cross-sectional analysis.