Assessing the hepatitis burden in drug users and prisoners in Luxembourg
Every year on 28th July is the World Hepatitis Day, coordinated by the World Hepatitis Alliance. This event aims to create awareness, prevent infection and fight against the disease. In Luxembourg, the prevalence of hepatitis C is estimated to 0.7% in the resident population. A national 5-year action plan to control the disease has been prepared. At LIH’s Infectious Diseases Research Unit, scientists working in collaboration with the “Centre Hospitalier de Luxembourg” are currently assessing the hepatitis burden in the most vulnerable populations: drug users and prisoners.
Hepatitis is characterised by a liver inflammation caused by the hepatitis viruses A, B or C and sometimes also induced by alcohol or drug abuse. The disease is often asymptomatic but can lead to severe liver destruction requiring an organ transplant. It is considered as chronical if it is present for more than six months. A vaccine is available against hepatitis A and B, but not yet against hepatitis C, which is considered to be the most dangerous form.
Two hepatitis studies are currently being conducted in Luxembourg with drug users and prisoners, two populations which are at high risk mainly because of the sharing of drug-injection equipment.
The first is an epidemiological and behavioural study with drug users that started in July 2015 and should enrol around 1000 participants. Its objective is to determine the seroprevalence, the genotype and the load of hepatitis C virus (HCV) in drug users, and to analyse drug consumption practices. This study shall allow to better understand the risk factors of HCV transmission, initiate a reflection to reduce the risks of transmission and ultimately improve the specific prevention campaigns for drug users in Luxembourg. The study is currently being performed at the drug advice centre Abrigado and at the “Centre Hospitalier de Luxembourg” (CHL) and will soon also be implemented at the foundation “Jugend- an Drogenhëllef” and the Red Cross centre “HIVBerodung”.
The second study is being carried out in two prisons in Luxembourg with prisoners admitted between July 2015 and June 2017. A previous study conducted in a penitentiary centre showed that 17.2% of prisoners who were treated in prison and recovered from the disease got re-infected within a period of three years. The new study therefore aims to accurately assess HCV re-infection in prison and after discharge. It will also allow to monitor the HCV treatment rate in prison and the response to treatment with current and new HCV therapies. In addition, the study will link the participants with the programme OST (Opioid Substitution Therapy) helping drug users to stop their consumption.
Both projects are led by Dr Vic Arendt from the National Service for Infectious Diseases at the CHL and Dr Carole Devaux from LIH’s Infectious Diseases Research Unit. LIH is in charge of the sequencing and phylogenetic analysis of the HCV strains in these patients. LIH’s Clinical and Epidemiological Investigation Centre is assisting with data collection and the recruitment of the drug users.