Changes in risk behavior and dynamics of hepatitis C virus infections among young drug users in Amsterdam, the Netherlands

To elucidate the character and magnitude of the hepatitis C virus (HCV) epidemic among drug users in Amsterdam, 197 young drug users from the period 2000 to 2004 were compared with 215 counterparts from 1985 to 1989. Although injection risk behavior and HCV seroprevalence decreased sharply over time, HCV seroprevalence remains high (44%) among young drug users who have ever injected. Phylogenetic analysis shows that current HCV infections originate from diversification of strains already circulating in the past, but also from the recent introduction of new subtypes. HCV subtypes la and 3a remain the most prevalent among drug users in Amsterdam, but other subtypes such as 4d and 2b have entered the population. In conclusion, both the unpopularity of injecting drug use and the success of prevention campaigns are likely to be responsible for the decline in the seroprevalence of HCV and increased median time to seroconversion. Treatment of those infected chronically, in combination with the continuation of prevention programs, might decrease future HCV transmission.