Behavioral characteristics of Appalachian community contribute to epidemic of hepatitis C

June 30, 2014 by Elizabeth Adams, University of Kentucky
The use of injection drugs is a factor contributing to the prevalence of hepatitis C in Appalachian communities.

High rates of injection drug use, little access to intervention services and tight-knit social circles have created a perfect storm for the spread of the hepatitis C virus in Appalachia.

University of Kentucky researchers have tracked cases of this highly infective virus in Appalachian drug users, with evidence that most new cases are affecting people under the age of 25. Since 2008, a research team led by Dr. Jennifer Havens, an epidemiologist in the University of Kentucky Center for Drug and Alcohol Research, has conducted routine testing and interviews with 500 drug users in Perry County. The goal of the study is to gain a better understanding the social and behavioral risk factors that contribute to the area's prevalence of hepatitis C, and ultimately use the knowledge to develop interventions aimed at curbing the spread of the disease.

Every six months, participants in the study engage in live interviews regarding drug use behaviors, sexual activity and social networks. In addition, researchers test participants for hepatitis C (HCV), herpes simplex II (HSV-2) and the human immunodeficiency virus (HIV).

The study has retained 95 percent of participants through five years, allowing the researchers to map support networks, drug use networks and sexual networks, as well as identify systemic changes in the drug use community. The researchers are also interested in monitoring the population for cases of HIV, a disease that has not yet been detected in the population but would transmit quickly if introduced.

"When you think about rural communities, you think of a tight knit group - everyone knows everyone else," Havens said. "And that's what is going on here. We are seeing great potential for disease transmission."

Nearly 43 percent of participants initially tested positive for HCV when the study began in 2008. About 80 percent of the participants have a lifetime history of injection drug use. In the past five years, the prevalence of the virus has risen to nearly 62 percent, with 94 new cases. The majority of new cases were diagnosed in people ages 18 to 25.

In most cases, the blood-born hepatitis C virus progresses to a chronic disease, ultimately leading to liver complications and failure. The Centers for Disease Control estimates 3 million Americans are infected with HCV, but thousands more are unknowingly carrying the virus.

Prior to joining UK, Havens studied inner-city drug using populations of Baltimore at Johns Hopkins Bloomberg School of Public Health. In Appalachia, known as the national epicenter for prescription drug abuse, recreational drug users are most likely to transmit HCV through injection of prescription medications and shared paraphernalia. In Baltimore, injection heroin use accounted for the spread of HCV. Also, Havens said many of the cases HCV seen in Appalachia are new infections, whereas in urban areas, many cases originated in the 70s and 80s.

Havens said Appalachian communities have the disadvantage of being isolated from drug intervention resources, such as mobile syringe exchanges that serve sections of Baltimore. Mobile syringe exchanges in larger cities provide drug users with sanitary tools, such as bleach kits, to prevent transmission, but more importantly a known community location for accessing .

"Frankly, what's going on down there is reflecting what's going on in the inner city," Havens said of Perry County. "I don't think what's going on is necessarily unique, but if you are looking at very small communities and the number of people I know of who are hepatitis C positive - that's really high relative to urban areas."

While new medications are providing patients with more options to manage hepatitis C, these treatments are not accessible or affordable for low-income and uninsured drug users. The latest pill found effective in treating the disease costs $90,000 or $1,000 per dose. Only 10 percent of the Appalachian study's participants have private insurance, while two-thirds are uninsured.

With five years of information about the high-risk behaviors and social networks of Appalachian drug users, researchers are equipped with information to develop the most effective intervention programs to reduce cases of hepatitis C. Havens said participants have voiced an interest in syringe exchange programs. Since at least five participants have died of drug overdose, Havens is also interested in designing an intervention program to reduce the risk of overdose.

While the current social networks increase the risk of HCV transmission, Havens said those same networks can be used as tools to disseminate information and health resources to otherwise isolated . Havens emphasizes that these populations will require available, accessible and affordable drug treatment to curb use and the growing rates of hepatitis C.

"Certainly prevention is the most important thing we can do," Havens said. "Increases in treatment would be helpful – not just availability and access, but more affordable treatment, better treatment and more accessible treatment."

Explore further: Researchers look to reduce Hep C infections with "Staying safe intervention" for injecting drug users

Related Stories

Researchers look to reduce Hep C infections with "Staying safe intervention" for injecting drug users

February 17, 2014
(Medical Xpress)—Despite a number of social/behavioral intervention and educational programs, the spread of hepatitis C (HCV) in people who inject drugs (PWIDs) remains a chronic problem.  Now, researchers affiliated with ...

Herpes virus infection drives HIV infection among non-injecting drug users in New York

June 28, 2014
HIV and its transmission has long been associated with injecting drug use, where hypodermic syringes are used to administer illicit drugs. Now, a newly reported study by researchers affiliated with New York University's Center ...

Study quantifies prevalence of chronic HCV infection

March 4, 2014
(HealthDay)—The prevalence of hepatitis C virus (HCV) infection is about 1 percent, with 2.7 million U.S. residents estimated as having chronic HCV infection, according to a study published in the March 4 issue of the Annals ...

HIV-HCV coinfection speeds HCV-related liver fibrosis

February 27, 2013
(HealthDay)—Individuals who are coinfected with HIV and hepatitis C virus (HCV) exhibit liver fibrosis similar to that of individuals without HIV who are nearly 10 years older, according to research published online Feb. ...

Newly incarcerated have one percent acute hepatitis C prevalence

March 19, 2013
A study published in the March issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, estimates that the prevalence of acute hepatitis C virus (HCV) infection is nearly one percent among ...

Understanding the strains of hepatitis

May 29, 2014
Hepatitis C is a very sneaky creature that coats itself in an envelope which changes every time the body tries to mount an immune response, says Kenneth Sherman, MD, PhD, a UC Health physician and professor in University ...

Recommended for you

Deadly Rift Valley fever: New insight, and hope for the future

July 19, 2018
Health control measures alone could be ineffective in the long term fight against the deadly Rift Valley fever which affects both humans and animals, a new study in the journal PNAS reports.

New guidelines to diagnose, manage rare endocrine disorders

July 19, 2018
International guidelines have been published for the first time to help doctors around the globe diagnose and manage patients with a very rare set of endocrine diseases known as pseudohypoparathyroidism and its related disorders, ...

Overuse of antibiotics not what the doctor ordered

July 19, 2018
With increased use of antibiotics worldwide linked to growing antibiotic resistance, a world-first study co-authored by a QUT researcher has highlighted the growing impact of non-prescription supply of antibiotics in community ...

Alcohol-related cirrhosis deaths skyrocket in young adults

July 18, 2018
Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

Hidden blood in feces may signal deadly conditions

July 17, 2018
(HealthDay)—Even if it's not visible to the naked eye, blood in the stool can be serious—a sign of a potentially fatal disease other than colon cancer, new research suggests.

Childhood abuse linked to greater risk of endometriosis, study finds

July 17, 2018
Endometriosis, a painful condition that affects one in 10 reproductive-age women in the U.S., has been linked to childhood physical and sexual abuse, according to findings published today in the journal Human Reproduction.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.