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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.

Background: Hepatitis C virus (HCV) infection is highly prevalent in illicit drug user populations, with three in four new HCV infections related to this risk behaviour and a growing HCV disease burden in Canada. Using data from a multi-site cohort study of illicit opioid users in five Canadian cities (OPICAN), this paper explores the prevalence and predictors of HCV status in this high-risk population., Methods: HCV status of cohort participants was assessed by salivary antibody test. Univariate relationships of HCV status with select variables were examined on the basis of cohort baseline data, and subsequently multivariate models using logistic regression to determine independent predictors of HCV status were generated., Results: 54.6% of the analysis sample (n=482) was HCV positive. Significant differences in terms of HCV prevalence existed across the sites. Significant variables in the final stepwise logistic regression model included age, site (Toronto), unprotected sex, injecting drug use, drug treatment and incarceration in past year, in addition to opioid use in combination with non-opioids., Discussion: Besides drug injecting, various other socio-behavioural factors were associated with HCV status in our cohort. On this basis, interventions focusing solely on injection risks are overly limited in scope to prevent HCV transmission in the high-risk population of illicit drug users and need to be broadened. Prevention efforts should also target young injectors as a priority.