Journal
LANCET INFECTIOUS DISEASES
Volume 16, Issue 12, Pages 1385-1398Publisher
ELSEVIER SCI LTD
DOI: 10.1016/S1473-3099(16)30325-5
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Funding
- Bill AMP
- Melinda Gates Foundation
- Australian National Health and Medical Research Council
- Bill AMP
- Melinda Gates Foundation
- Australian National Health and Medical Research Council
- Medical Research Council [MR/K023233/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0515-10023, 12/136/105, RP-DG-0610-10055] Funding Source: researchfish
- MRC [MR/K023233/1] Funding Source: UKRI
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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% (216000,101000-338000) 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. Copyright (C) The Author(s). Published by Elsevier Ltd.
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