The HITS study: modes of transmission, natural history and determinants of outcome from primary hepatitis C infection

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Hepatitis C (HCV) affects approximately 200,000 Australians, of whom a significant minority develop long term complications, including cirrhosis, liver failure and liver cancer. The dominant mode of transmission of this virus is via blood-to-blood contact, particularly via injecting drug use. Prisons appear to be a key focus of transmission of hepatitis C in the community as the majority of inmates are incarcerated for drug-related crimes, and injecting drug use remains prevalent whilst in prison. In addition, as almost one in two inmates are already infected at the time of incarceration, those who are uninfected appear to be at significant risk of becoming infected through other (non-injecting) routes such as tattooing, fights and other coincidental blood exposures. This application seeks support for the HITS study (Hepatitis C Incidence and Transmission in Prisons study) - a prospective cohort study of inmates of NSW prisons. Following a successful pilot in which the substantial bureaucratic and logistical hurdles were resolved, the main cohort has been enroling since late 2000. The initial data have confirmed a high rate of at risk behaviour amongst inmates and three primary HCV infections acquired in prison have been documented featuring an unusual antibody negative pattern which would typically pass undetected in screening assays for HCV infection. After exposure to HCV and the development of primary infection, approximately one in five individuals successfully resolves the infection and clears the virus, presumably via an efficient immune response or a non-virulent virus, or a combination of these factors. Therefore, in addition to the public health aspects of the HITS study, the research also aims to define the immunological and virological factors which allow clearance of HCV. These studies will provide key information to guide treatment and immunisation strategies against hepatitis C.