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The European Journal of Public Health 2001 11(4):425-430; doi:10.1093/eurpub/11.4.425
© 2001 by European Journal of Public Health
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INFECTIOUS DISEASES

HIV and hepatitis virus infections among injecting drug users in a medically controlled heroin prescription programme

THOMAS STEFFEN1,2,*, RICHARD BLATTLER1, FELIX GUTZWILLER2 and MARCEL ZWAHLEN3

1 Addiction Research Institute Zurich, Switzerland
2 Institute for Social and Preventive Medicine, University of Zurich Switzerland
3 Swiss Federal Office of Public Health Switzerland

12* Dr Thomas Steffen, MD, MPH, Giornicostr. 98, CH-4059 Basel, Switzerland, tel. +41 61 3315700, fax +41 61 3338135, e-mail: thomassteffen{at}bluewin.ch

Background: In Switzerland, 1,035 patients were accepted for admission to the medically controlled prescription of narcotics programme (PROVE) from 1 January 1994 until 31 December 1996. Heroin, methadone, and morphine were prescribed. This paper presents the prevalence and incidence of HIV and hepatitis B/C infections in the sociomedical context of the participants. Methods: Admission criteria were a minimum age of 20 years, at least a two-year duration of daily heroin consumption, a negative outcome of at least two previous treatments, and documented social and health deficits as a consequence of their heroin dependence. The patients were examined at admission and every six months. A serological test was carried out at the same time for HIV and hepatitis B/C. Results: Serological testing on admission could be performed in more than 80% of the entrants and documented a very high seroprevalence of antibodies against HBcore (73%) and HCV (82%). The prevalence of HIV and hepatitis B/C increased with duration of drug intake. In the follow-up analysis of seronegative individuals, a halving of the risk of viral hepatitis infection was shown when comparing the first six months with the period greater then six months after PROVE entry. Conclusion: The tests conducted showed high prevalence and incidence rates of HIV and hepatitis B/C among patients who had consumed intravenous drugs for years. The descriptive analysis in heroin-assisted treatment showed a reduction in infection risk for viral hepatitis corresponding to the lower risk behaviour of patients.

Keywords: AIDS, hepatitis B, hepatitis C, heroin, injecting drug users, public health, prevention


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