Hepatitis C seroconversion in methadone maintenance treatment programs in Wuhan, China.

BACKGROUND AND AIMS

To decrease infectious disease transmission, China is expanding methadone maintenance treatment (MMT). This study evaluated the prevalence of hepatitis C virus (HCV) infection at MMT entry, seroconversion rates after admission and potential risk factors for HCV seroconversion during MMT in Wuhan, China.

DESIGN

Cross-sectional survey of all patients entering MMT and prospective follow-up of patients HCV seronegative at admission.

SETTING

All MMT clinics in Wuhan, China.

PARTICIPANTS

A total of 12 755 opiate-dependent individuals entering MMT between May 2006 and June 2011; 1200 participants HCV seronegative at admission were followed.

MEASUREMENTS

Serological tests for HCV and self-report data on risk behaviors at MMT admission; urine toxicology results and repeated assessments of serological status and risk behaviors during treatment on patients HCV seronegative at admission.

FINDINGS

HCV seroprevalence at admission was 72.1% [95% confidence interval (CI) = 71.3-72.9%] and 555/1200 (46.3%, 95% CI = 43.5-49.1%) patients seroconverted to HCV during MMT. The mean time to HCV seroconversion was 3 (95% CI = 2.84-3.07) years with a cumulative seroconversion rate of 34.5 (95% CI = 31.5-36.9) per 100 person-years. Significant predictors of HCV conversion included injection drug use in the past 30 days [relative hazard (RH) 2.0, 95% CI: 1.6 - 2.4, P=0.002] and the rate of opiate-positive urine tests during MMT (RH 2.0, 95% CI = 1.3-3.1, P<0.001).

CONCLUSIONS

Methadone maintenance treatment patients in Wuhan, China show a high prevalence of hepatitis C virus at admission (72.1%) and a high rate of seroconversion during treatment (46.3%). Seroconversion is associated with continuing injection drug use.