Injection of drug residue as a potential risk factor for HCV acquisition among Montréal young injection drug users (2012)

Background: Preparing drugs or medications for injection may leave residues in containers and filters used by injection drug users (IDUs). Little is known about the specific practice of injecting someone else's drug residue as a possible route of HCV transmission.
Methods: A prospective cohort study of street youth aged 14-23 years old was carried out between July 2001 and December 2005. For this analysis, youth who injected in the six months prior to interview were selected if they were HCV-negative and had completed at least one follow-up visit. Semi-annual visits involved completing an interviewer-administered questionnaire and providing a blood sample for HCV antibody testing. "Sharing behaviors" (any injection preparation behavior that could entail IDUs using injection equipment used by others) including injecting someone else's drug residue were assessed at each interview. Predictors of HCV seroconversion were identified using Cox proportional hazards regression analyses. Two multivariate models were built, one considering sharing behaviors only, and one with cocaine injection forced into it.
Results: Of the 175 participants, 60% were male and their mean age was 20.7 years old. In both models, residue injection was a predictor of HCV incidence, although with marginal statistical significance. The adjusted hazard ratio estimates were (2.15; 95% CI 0.99-4.67) and (2.11; 95% CI 0.97-4.62) respectively.
Conclusion: This epidemiological study underscores the role injection of drug residue may play in HCV transmission among IDUs. In the current context of the worldwide HCV epidemics, this question deserves further investigation.