Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013

Degenhardt, Louisa, Charlson, Fiona, Stanaway, Jeff, Lamey, Sarah, Alexander, Lily T., Hickman, Matthew, Cowie, Benjamin, Hall, Wayne D., Strang, John, Whiteford, Harvey and Vos, Theo (2016) Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Lancet Infectious Diseases, 16 12: 1385-1398. doi:10.1016/S1473-3099(16)30325-5


Author Degenhardt, Louisa
Charlson, Fiona
Stanaway, Jeff
Lamey, Sarah
Alexander, Lily T.
Hickman, Matthew
Cowie, Benjamin
Hall, Wayne D.
Strang, John
Whiteford, Harvey
Vos, Theo
Title Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013
Journal name Lancet Infectious Diseases   Check publisher's open access policy
ISSN 1474-4457
1473-3099
Publication date 2016-12-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/S1473-3099(16)30325-5
Open Access Status Not yet assessed
Volume 16
Issue 12
Start page 1385
End page 1398
Total pages 14
Place of publication London, United Kingdom
Publisher Lancet Publishing Group
Language eng
Subject 2725 Infectious Diseases
Abstract Background Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013.
Formatted abstract
Background: Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013.

Methods: We modelled the burden of HBV and HCV (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted United Nations data on the proportion of notified HIV cases by transmission route, and estimated the contribution of injecting drug use (IDU) to HBV and HCV disease burden by use of a cohort method that recalibrated individuals' history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injecting drug users and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability-adjusted life-years (DALYs), with 95% uncertainty intervals (UIs) calculated for each metric.

Findings: In 2013, an estimated 10·08 million DALYs were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990. In total in 2013, IDU was estimated to cause 4·0% (2·82 million DALYs, 95% UI 2·4 million to 3·8 million) of DALYs due to HIV, 1·1% (216 000, 101 000–338 000) of DALYs due to HBV, and 39·1% (7·05 million, 5·88 million to 8·15 million) of DALYs due to HCV. IDU-attributable HIV burden was highest in low-to-middle-income countries, and IDU-attributable HCV burden was highest in high-income countries.

Interpretation: IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up.

Funding: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.
Keyword Infectious Diseases
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Public Health Publications
 
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