According to WHO estimates there can be 180  million people may be chronically infected hepatitis C (HCV) compared to estimated 33 million [30 million—36 million] people living with HIV.

HCV presents an important public health problem. As many as 85% of people infected with HCV may go on to become chronic carriers of the disease with the risk of developing cirrhosis - according to different estimates from 5-20% [1] to 20-30% [2], or liver cancer. At present, it is the most common cause of chronic liver disease and liver transplantation in a number of countries, with an estimated 250 000 people dying annually from HCV-related causes [3].

Infection with the hepatitis C virus (HCV), mainly blood borne is widespread amongst injecting drug users (IDUs). The infection spreads rapidly in this group due to its high infectivity (about 10 times higher than HIV) [4]. While HIV and HCV share the same routes of transmission and therefore co-infection is common among IDUs living with HIV —however, unlike HIV—it can be transmitted by sharing not only needles but also other injecting equipment (e.g., water, cotton, etc.) putting drug injectors at increased risk of HCV [3]. Since the introduction of blood testing in the 90-ies ongoing transmission now occurs mostly among people injecting drugs. Sharing sniffing, tattoo or piercing material are also well established routes of transmission [5].

Overall, there is little systematic and updated data on HCV prevalence, but data available demonstrates, that in the region the scale of HCV prevalence among IDUs is high. A few trends can be outlined:

• Among new EU countries the prevalence is lower in the Central European countries that also have comparatively low HIV prevalence related to drug injecting (Bulgaria, Czech Republic, Hungary, Slovenia and Slovakia) varying from 7% to over 40% (with lowest in Bulgaria, Czech Republic, Hungary and higher in Slovenia, Slovakia and Romania) when compared to Baltic states (Estonia, Latvia and Lithuania) where the infection varies from 70 to over 90% [6].

• At the same time, high prevalence in sample testing reported from Bulgaria, Czech Republic, Poland, Romania and Slovenia suggests that HCV is high among IDUs throughout the region, even in countries with low HIV transmission rates among drug injectors [5].

• High transmission rate continues further to the East – from 70% to 90% in Ukraine and over 90% in Russia [5]. Eastern Europe also has high rates of HIV/HCV co-infection, which keeps rising – up to 80% among people living with HIV and seeking treatment in Estonia and Ukraine and over 90% in samples tested in Russia [5].

• In Central Asia countries – Azerbaijan, Kazakhstan and Tajikistan report prevalence of more than 50% [7].

Timely introduction of interventions targeting IDUs in the Central part of Europe helped to prevent high transmission rates in such counties as Czech Republic, Slovenia, when compared to most of the Eastern countries. However, throughout the region, the harm reduction serves were introduced and developed mainly in response to the emerging HIV epidemic.

While HCV can be transmitted sexually, it does to a much lesser extent than through drug use and other associated risk behaviors, plus the introduction of blood screening for HCV dramatically reduced viral transmission through transfusion of infected blood, leaving unsafe injecting drug use as the main cause of transmission. This results in less available funding for HCV focused prevention, when compared to HIV, therefore most of interventions focused on HCV may be short-lived rather than long term practices.

EHRN assessment in 2007 in 13 countries of the region showed that most of the initiatives directed at testing and counseling of IDUs about HCV are sporadic and depend on (mainly) limited funding (Estonia, Lithuania, Slovakia). HCV testing also is poorly linked to established harm reduction services, commonly provided at the Centers for addiction treatment (in Lithuania, Poland, Russia, Slovakia and Slovenia) and only few of the countries (Bulgaria, Czech Republic, Hungary and Slovenia) indicated that they provide training on safe injecting related to HCV prevention.

[1] Edlin B (2004) Hepatitis C prevention and treatment for substance users in the United States: acknowledging the elephant in the living room. International Journal of Drug Policy, 2004 April; 15(2):81-91.

[2] Collins S, Swan T (2007) Guide to hepatitis C for people living with HIV: testing, coinfection, treatment and support. Published by Monument Trust.

[In English]

[3] Lavanchy D (2004). Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. Journal of Viral Hepatitis, 2004;11(2):97-107.

[4] Hagan H, Thiede H, Weiss N et al. (2001). Sharing of drug preparation equipment as a risk factor for hepatitis C. American Journal of Public Health, 2001;91:42–6.

[5] CEEHRN/EHRN (2007). Hepatitis C prevention, treatment and support among injecting drug users in the new EU Member States and neighboring countries: situation, guidelines and recommendations. Eurasian Harm Reduction Network, 2007, Vilnius, Lithuania.

[In English] [In Russian]

[6] EMCDDA (2008). Statistic Bulleting 2008. European Monitoring Centre for Drugs and Drug Addiction, Lisbon.

[In English]

[7] Cook C & Kanaef N. (2008). Global State of Harm Reduction 2008. Mapping the response to drug-related HIV and Hepatitis C epidemic. International Harm Reduction Association, London.

[In English]