Department of the Epidemiology Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut.
Department of Anthropology, University of Colorado, Denver.
J Infect Dis. 2018 Jan 17;217(3):466-473. doi: 10.1093/infdis/jix427.
Controlling hepatitis C virus (HCV) transmission among people who inject drugs (PWID) has focused on preventing sharing syringes and drug preparation paraphernalia, but it is unclear whether HCV incidence linked to sharing paraphernalia reflects contamination of the paraphernalia or syringe-mediated contamination when drugs are shared.
In experiments designed to replicate real-world injection practices when drugs are shared, the residual contents of HCV-contaminated syringes with detachable or fixed needled were passed through the "cookers" and filters used by PWID in preparing drugs for injection and then introduced into a second syringe. All items were tested for the presence of infectious HCV using a chimeric HCV with a luciferase gene.
Hepatitis C virus could not be recovered from cookers regardless of input syringe type or cooker design. Recovery was higher when comparing detachable needles to fixed needles for residue in input syringes (73.8% vs 0%), filters (15.4% vs 1.4%), and receptive syringes (93.8% vs 45.7%).
Our results, consistent with the hypothesis that sharing paraphernalia does not directly result in HCV transmission but is a surrogate for transmissions resulting from sharing drugs, have important implications for HCV prevention efforts and programs that provide education and safe injection supplies for PWID populations.
控制注射吸毒人群（PWID）中的丙型肝炎病毒（HCV）传播一直集中在防止共用注射器和毒品制备用具上，但尚不清楚与共用用具相关的 HCV 发病率是否反映了用具的污染或共用药物时注射器介导的污染。
在旨在复制共享毒品时真实注射实践的实验中，将带有可拆卸或固定针头的 HCV 污染注射器的残留内容物通过 PWID 在准备注射药物时使用的“炊具”和过滤器传递，然后引入第二支注射器。使用带有荧光素酶基因的嵌合 HCV 对所有物品进行存在传染性 HCV 的检测。
无论输入注射器类型或炊具设计如何，HCV 都无法从炊具中回收。与固定针头相比，可拆卸针头的残留物在输入注射器（73.8%对 0%）、过滤器（15.4%对 1.4%）和接受注射器（93.8%对 45.7%）中的回收率更高。
我们的结果与共享用具不会直接导致 HCV 传播而是共享药物导致传播的替代物这一假设一致，这对 HCV 预防工作和为 PWID 人群提供教育和安全注射用品的项目具有重要意义。
