Hepatitis C seroconversion in methadone maintenance treatment programs in Wuhan, China.

Background and aimsTo decrease infectious disease transmission, China is expanding methadone maintenance treatment (MMT). This study evaluated the prevalence of hepatitis C virus (HCV) infection at MMT entry, seroconversion rates after admission and potential risk factors for HCV seroconversion during MMT in Wuhan, China. DesignCross-sectional survey of all patients entering MMT and prospective follow-up of patients HCV seronegative at admission. SettingAll MMT clinics in Wuhan, China. ParticipantsA total of 12755 opiate-dependent individuals entering MMT between May 2006 and June 2011; 1200 participants HCV seronegative at admission were followed. MeasurementsSerological tests for HCV and self-report data on risk behaviors at MMT admission; urine toxicology results and repeated assessments of serological status and risk behaviors during treatment on patients HCV seronegative at admission. FindingsHCV seroprevalence at admission was 72.1% [95% confidence interval (CI)=71.3-72.9%] and 555/1200 (46.3%, 95% CI=43.5-49.1%) patients seroconverted to HCV during MMT. The mean time to HCV seroconversion was 3 (95% CI=2.84-3.07) years with a cumulative seroconversion rate of 34.5 (95% CI=31.5-36.9) per 100 person-years. Significant predictors of HCV conversion included injection drug use in the past 30 days [relative hazard (RH) 2.0, 95% CI: 1.6 - 2.4, P=0.002] and the rate of opiate-positive urine tests during MMT (RH 2.0, 95% CI=1.3-3.1, P<0.001). ConclusionsMethadone maintenance treatment patients in Wuhan, China show a high prevalence of hepatitis C virus at admission (72.1%) and a high rate of seroconversion during treatment (46.3%). Seroconversion is associated with continuing injection drug use.