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    Remaining Hepatitis C Virus in Syringes Depends on Needle-Syringe Design and Dead Space Volume

    Background
    Hepatitis C Virus prevalence in people who inject drugs (PWID) ranges from 40%-90%. The volume of residual fluid within syringes depends on needle size and length, amount of space remaining in the hub of the syringe once the needle is attached and if the needles are detachable from the syringe barrel. Although they retain the least volume, syringes with fixed needles are not always acceptable to people who inject drugs (PWID). This has lead to the development of detachable needle-syringe combinations to reduce dead space.

    Findings

    • The 1ml insulin syringes with fixed needles were the most effective at reducing HCV retention in syringes.
    • This remained the case whether HCV recovery was assessed immediately after use, after storage at room temperature, or after rinsing with water.
    • Authors found that Noloss low dead space (LDS) syringes with standard needles and the standard Nevershare syringes with Total Dose LDS needles retained levels of viable HCV comparable to high dead space (HSD) immediately after use.
    • Specific recommendations cannot be made for any one LDS syringe-needle combination over the others or in place of od HDS syringes due to inconsistent patterns across the three experiments (immediate testing, storage, and rinsing with water).
    • At this time, lower dead syringes cost more without providing much benefit, therefore economically, there is no benefit to recommending them as an HCV prevention measure.

    Summary
    People who inject drugs who use syringes with larger volumes and detachable needles need to be made aware that they are at increased risk for HCV transmission compared to fixed needle syringes if injection equipment is reused. This applies even when using two part low dead space (LDS) syringes and after several rinses with water. HCV prevention should focus on traditional harm reduction approaches such as preparing drugs and injecting them only with new, sterile equipment, minimizing contamination of injection locales, and hypochlorite bleach disinfection. Further research is needed on the overall impact of syringe type on HCV transmission among people who inject drugs.

    Binka, M., Painstil, E., Patel, A. et al. (2015).Survival of Hepatitis C Virus in Syringes Is Dependent on the Design of the Syringe-Needle and Dead Space Volume. PLOS.