This has been discussed here often

[orleans]

Evidence to support belief in transmission of hepatitis C by sharing drug sniffing equipment
Last updated:11September2008

Roger Pebody, Aidsmap September 11, 2008
Hepatitis C can be detected in the nasal passage, and in straws which are inserted in the nose, report researchers in the October 1st edition of Clinical Infectious Diseases. Their findings support the hypothesis that hepatitis C can be transmitted by sharing straws or banknotes which are used to snort drugs.

The theory of hepatitis C transmission through this route is that frequent or long-term sniffing or snorting of drugs such as cocaine can cause damage and bleeding in the nasal passage. Straws or banknotes that are inserted in the nose could come into contact with hepatitis C infected blood or mucus, which may then be transmitted to someone else sharing the same straw.

In recent years there have been numerous outbreaks of hepatitis C among HIV-positive gay men in Europe. Whilst there is a growing body of evidence that infection is associated with sexual practices including fisting, use of sex toys and group sex, some studies have also suggested that sniffing drugs may contribute to transmission.

At the same time, in many countries up to a quarter of hepatitis C infections remain unexplained, with individuals reporting no risky practices such as use of shared drug injection equipment.

And a number of epidemiological studies in largely HIV-negative populations (typically, blood donors or street drug users who do not inject) have found an association between snorting drugs and hepatitis C infection. Nonetheless not all studies have reported this finding, and there have been some criticisms of the methodological quality of these studies.

However, until now no study has examined the virological plausibility of the belief that sharing equipment to sniff drugs may contribute to hepatitis transmission. Investigators in New York therefore recruited 38 adults who snort drugs and have hepatitis C at a neighbourhood health clinic.

Tests conducted included:


Nasal swabs to test for the presence of hepatitis C and blood in the nasal passage
Each subject was asked to inhale air through plastic straws, which were then tested for hepatitis C and blood
An examination of the nasal cavity to check for disease.
In these tests, hepatitis C RNA was detected using the same sort of technology as a viral load test.

A third of the sample was coinfected with HIV, and 45% with hepatitis B. Hepatitis C viral load varied widely in the sample, with a mean of 5000 copies/ml. Liver function tests for ALT (alanine aminotransferase) indicated some damage, with a mean of 47 u/l.

The researchers were able to detect hepatitis C on 13% of the nasal swabs, and on 5% of the sniffing straws.

Blood was detected in the samples more frequently than hepatitis C. However whether blood was present or not did not predict whether hepatitis could be found. For example, of the five nasal swabs that were positive for hepatitis, there were no traces of blood on two of them.

Pathologies and damage to the nasal passage could increase the risk of hepatitis transmission. Among other problems, more than four out of ten subjects reported having a runny or stuffy nose at least once a week. Rates of inflammation of the nasal membrane were high at 71%, while rates of inflammation of the sinuses were normal.

It is known that hepatitis C can remain infectious outside the body for up to 16 hours. However the authors acknowledge that little is known about the quantity of virus needed for transmission. They suggest that when drugs are being snorted, there is greater discharge of nasal fluids and blood, and the quantity of virus is likely to be larger.

The authors believe that their most significant finding is that hepatitis C can be transferred onto sniffing implements. Nonetheless they recommend further studies to confirm this mode of transmission and its contribution to the spread of hepatitis C.

Reference
Aaron S et al. Intranasal transmission of hepatitis C virus: virological and clinical evidence. Clinical Infectious Diseases 47: 931-934, 2008.

[CoWriter]

"For example, of the five nasal swabs that were positive for hepatitis, there were no traces of blood on two of them."

Very interesting.  Thanks for posting it.  Here's another study on crack pipes......



Jan 2008

Crack Pipes Can Transmit Hepatitis C Virus

It is well established that hepatitis C virus (HCV) can be transmitted through sharing needles, cookers, and other equipment for drug injection. Studies have also shown that non-injection drug-use practices may spread the virus, such as sharing straws or bills to snort cocaine.

Now, a study reported in the January 2008 European Journal of Gastroenterology and Hepatology offers evidence that crack pipes may transmit HCV.

Canadian researchers conducted an exploratory study to try to detect HCV on crack-use paraphernalia. Equipment was collected from 51 street crack users within 60 minutes after use. Participants also provided saliva samples to test for HCV antibodies and had digital photographs taken of their mouths to assess the presence of oral sores.

Results
• 22 of the participants (43%) were HCV antibody positive.

• A minority of the study participants had oral sores.

• 1 of the 51 pipes (2%) tested positive for HCV RNA.

• This pipe was made from a glass stem.

• Its owner was HCV antibody positive and had obvious oral sores.
ConclusionIn conclusion, the investigators wrote, "HCV transmission from an infected host onto paraphernalia as a precondition of HCV host-to-host transmission via shared crack paraphernalia use seems possible, with oral sores and paraphernalia condition constituting possible risk modifiers."

According to lead author Benedikt Fischer of the University of Victoria Center for Addictions Research, the findings imply that "in order to prevent the spread of hepatitis C in the high-risk population of street drug users, you need to not only focus on injection drug users but also on crack smokers."

Centre for Addictions Research of British Columbia, Victoria, Canada; Toronto General Hospital, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; Institute for Public Health and Addiction Research, Zürich, Switzerland.

1/29/08Reference
B Fischer, J Powis, MF Cruz, and others. Hepatitis C virus transmission among oral crack users: viral detection on crack paraphernalia. European Journal of Gastroenterology and Hepatology 20(1): 29-32. January 2008.

[orleans]

Man, I'm glad my drug days are decades in the past. At least I won't have to worry about re-infection, IF I'm fortunate enough to get rid of it this time. Boy are yer dumb when yer young! jerry