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Hepatitis C virus transmission among oral crack users: viral detection on crack paraphernalia

Fischer, Benedikta c; Powis, Jeffb; Cruz, Michelle Firestonec; Rudzinski, Katherinea c; Rehm, Jürgenc d

European Journal of Gastroenterology & Hepatology: January 2008 - Volume 20 - Issue 1 - p 29-32
doi: 10.1097/MEG.0b013e3282f16a8c
Original Articles: Hepatitis and Ethanol Abuse

Objective Epidemiological studies present oral crack use as a potential independent risk factor for hepatitis C virus (HCV) status, yet actual HCV transmission pathways via crack use have not been evidenced. To this end, this exploratory study sought to detect HCV on crack-use paraphernalia used by street crack users.

Methods Crack-use paraphernalia within 60 min of use was collected from 51 (N) street-crack users. HCV RNA detection was conducted through eluate sampling and manual RNA extraction. Participants provided a saliva sample to test for HCV antibody, and had a digital photograph taken of their oral cavities, to assess the presence of oral sores as a possible risk factor for oral HCV transmission.

Results About 43.1% (n=22) of the study participants were HCV-antibody positive. One (2.0%) of the 51 pipes tested positive. A minority of the participants presented oral sores. The pipe on which HCV was detected was made from a glass stem; its owner was HCV-antibody positive, and there was full rater agreement on the presence of oral sores in the pipe owner's oral cavity.

Conclusions 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. Larger-scale studies with crack users are needed to corroborate our findings.

aCentre for Addictions Research of British Columbia, Victoria

bToronto General Hospital

cCentre for Addiction and Mental Health, Toronto, Canada

dInstitute for Public Health and Addiction Research, Zürich, Switzerland

Correspondence to Benedikt Fischer, PhD, CARBC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2

Tel: +250 853 3132; fax: +250 472 5321;


Received 22 May 2007 Accepted 26 July 2007

© 2008 Lippincott Williams & Wilkins, Inc.