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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Gastroenterology. Author manuscript; available in PMC 2013 June 24.
Published in final edited form as:
PMCID: PMC3690554
NIHMSID: NIHMS467154

More Rare Birds, and the Occasional Swan

Dear Sir:

Your January Comment from the Editor1 described several North American acute hepatitis C cohorts. We describe here two additional cohorts (Table 1). In both studies, infections have been identified prospectively, avoiding the selection bias inherent in studying patients who have sought medical attention.

Table 1
Additional Acute Hepatitis C Cohorts in North America

Urban Health Study

The Urban Health Study recruited semiannual cross-sections of persons who injected illicit drugs from the streets and other natural settings in inner-city neighborhoods in the San Francisco Bay area.2 Of nearly 14,000 persons enrolled from 1986 through 2002, nearly 5,000 participated more than once (mean, 4.5 visits), comprising a passive, embedded cohort.3 Participants were interviewed, tested for HIV antibody, and given harm reduction counseling and referrals to needed services. Data from the interviews, blood samples, and add-on studies were used to study health and illness among persons who inject illicit drugs and evaluate interventions. Findings from this cohort have been published in more than 100 articles, describing basic biological, clinical, immunological, and epidemiologic investigations; social and behavioral studies; and research on health services, health policy, and legal policy.2-7 From 1998 through 2002, 4,018 study participants received hepatitis B and C serologic testing, of whom 3548 (88%) tested positive for antibodies to the hepatitis C virus (HCV). Of those testing negative, 84 returned for a subsequent visit, and 24 tested positive for HCV antibody, representing prospectively identified seroconversions. Retrospective testing of stored serum identified an additional 43 seroconversions during 1986-1998. Ongoing analyses are examining HCV prevalence, incidence, and risk factors, and genetic factors associated with resistance to viral infection and persistence.

Swan Project

The Swan Project began recruiting injection drug users (IDUs) aged 18-35 on the Lower East Side of Manhattan in 2005; > 500 IDUs have been interviewed and tested for HIV and HCV antibody, and 150 who have tested HCV antibody-negative have enrolled in a prospective cohort. Cohort members undergo biweekly risk behavior interviews and HCV RNA testing to detect new HCV infections as soon as possible after they are acquired, along with counseling and referrals to needed services. Biweekly interviewing and testing has proved feasible, reveals more risk behavior than quarterly or semiannual interviewing, and identifies the timing of risk behavior and infections more precisely, providing increased power to detect associations between specific injection practices and contexts and HCV acquisition. Identifying these risk factors is urgent because HCV still spreads rapidly among IDUs even where access to sterile syringes has dramatically reduced transmission.5 The incidence of new infections in Swan participants during follow-up fell three-fold from 2005 to 2007, while the incidence during the period immediately preceding enrollment, calculated using data on window period infections,8 did not fall, suggesting that the reduction might have resulted from our intervention. We are prospectively studying the clinical features, immunology, and virology of acute infection, and comparing those who clear infection, those who develop chronic infection, and those who remain uninfected. We have found HCV-specific cellular responses in nearly 50% of seronegative, HCV RNA-negative persons in this cohort.9 Our study provides the rare opportunity to analyze blood specimens collected before infection and then from the same persons weekly during acute infection. Participants who do not clear infection within 90 days are offered antiviral treatment through a unique multidisciplinary program.10 To date, we have identified 21 prospectively observed infections, 18 persons in the seronegative window period on enrollment, 3 recent seroconverters, and 12 possible reinfections.

Acknowledgement

The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government

Funding This article was funded by grants #R01-DA09532, R01-DA12109, R01-DA13246, R01-DA16159, R01-DA021550, and R01-DA03574 from National Institute on Drug Abuse (NIDA), NIH; M01-RR000047 and UL1-RR024996 from National Center for Research Resources (NCRR), NIH; H79-TI12103 from Substance Abuse and Mental Health Services Administration (SAMHSA); contracts #NO1-CO-12400 and N02-CP-91027 from National Cancer Institute (NCI), NIH; funding from the Department of Public Health of the City and County of San Francisco (SFDPH); and the intramural research programs of NCI and NIDDK, NIH.

Abbreviations

HCV
hepatitis C virus
NCI
National Cancer Institute
NCRR
National Center for Research Resources
NIDDK
National Institute of Diabetes and Digestive and Kidney Diseases
NIDA
National Institute on Drug Abuse
NIH
National Institutes of Health
SAMHSA
Substance Abuse and Mental Health Services Administration
SFDPH
Department of Public Health of the City and County of San Francisco
SUNY
State University of New York
UCSF
University of California, San Francisco

Footnotes

Conflicts of interest The authors disclose no conflicts.

References

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2. Watters JK, Estilo MJ, Clark GL, et al. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271(2):115–20. [PubMed]
3. Kral AH, Bluthenthal RN, Lorvick J, et al. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357(9266):1397–401. [PubMed]
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