@article{ec49ea6f19204c968162de9fd4eab1c0,
title = "The Effect of Female Sex on Hepatitis C Incidence among People Who Inject Drugs: Results from the International Multicohort InC3 Collaborative",
abstract = "The objective of this study was to assess differences in hepatitis C virus (HCV) incidence by sex in people who inject drugs (PWID), using a large international multicohort set of pooled biological and behavioral data from prospective observational studies of incident human immunodeficiency virus (HIV) and HCV infections in high-risk cohorts (the InC3 Collaborative). Methods. HCV infection date was estimated based on a hierarchy of successive serological (anti-HCV), virological (HCV RNA), and clinical (symptoms and/or liver function tests) data. We used a Cox proportional hazards model to calculate the crude and adjusted female to male (F:M) hazard ratio (HR) for HCV incidence using biological sex as the main exposure. Results. A total of 1868 PWID were observed over 3994 person-years of observation (PYO). Unadjusted F:M HR was 1.38 (95% confidence interval [CI], 1.15-1.65) and remained significant after adjusting for behavioral and demographic risk factors (1.39 [95% CI, 1.12-1.72]). Although syringe and equipment sharing were associated with the highest HCV incidence rate in women (41.62 and 36.83 PYO, respectively), we found no sex differences attributed to these risk factors. Conclusions. Our findings indicate that women who inject drugs may be at greater risk of HCV acquisition than men, independent of demographic characteristics and risk behaviors. Multiple factors, including biological (hormonal), social network, and differential access to prevention services, may contribute to increased HCV susceptibility in women who inject drugs.",
keywords = "Sex, hepatitis C virus, incidence, people who inject drugs, survival analysis",
author = "Aryan Esmaeili and Ali Mirzazadeh and Morris, {Meghan D.} and Behzad Hajarizadeh and Sacks, {Henry S.} and Lisa Maher and Jason Grebely and Kim, {Arthur Y.} and Georg Lauer and Cox, {Andrea L.} and Margaret Hellard and Paul Dietze and Julie Bruneau and Shoukry, {Naglaa H.} and Dore, {Gregory J.} and Lloyd, {Andrew R.} and Maria Prins and Kimberly Page",
note = "Funding Information: Financial support. InC3 was funded by the NIDA (grant number R01DA031056). Research support for the InC3 cohorts includes The Netherlands National Institute for Public Health and the Environment to the ACS; BBAASH, NIH (grant number U19 AI088791); BAHSTION is funded under NIH National Institute of Allergy and Infectious Diseases grant U19 U19 AI066345; ATAHC, NIDA (grant number R01 DA 15999-01); HITS-p, National Health and Medical Research Council of Australia (NHMRC), Project No. 222887, Partnership No. 1016351, Program Nos. 510488 and 1053206; HITS-c, University of New South Wales Hepatitis C Vaccine Initiative and NHMRC Project Grant No. 630483; Networks/ MIX, NHMRC Project Grants Nos. 331312 and 545891 and the Victorian Operational Infrastructure Support Programme (Department of Health, Victoria, Australia); HepCo, Canadian Institutes of Health Research (MOP-103138 and MOP-106468; R{\'e}seau SIDA Maladies Infectieuses, Fonds de la Recherche du Qu{\'e}bec-Sant{\'e}); HCVC, Australian National Health and Medical Research Council (project grant number 991357); UFO, NIH R01 DA016017. G. J. D., J. G., M. H., A. R. L., and L. M. receive fellowship support from the Australian National Health and Medical Research Council. N. H. S. receives support from the Fonds de la Recherche du Qu{\'e}bec-Sant{\'e}, Canada. In addition to the grant support for the InC3 research, K. P. receives support from 3R01 DA016017, 1ULTR001449, and U54GM104944.",
year = "2018",
month = jan,
day = "1",
doi = "10.1093/cid/cix768",
language = "English",
volume = "66",
pages = "20--28",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "1",
}