Arch Virol. 2013 Jul;158(7):1555-60.

HCV infection among cocaine users in the state of Pará, Brazilian Amazon.

Oliveira-Filho AB, Sawada L, Pinto LC, Locks D, Bahia SL, Brasil-Costa I, Lemos JA.

Faculdade de Ciências Naturais, Campus do Marajó, Breves, Universidade Federal do Pará, Av. Anajás, s/n. Aeroporto, Breves, PA, Brazil.


In this study, the prevalence, genotype frequency, and risk factors for HCV infection in 384 cocaine users were determined. One hundred twenty-four (32.3 %) cocaine users had anti-HCV antibodies and 120 (31.3 %) had HCV-RNA. Genotyping results indicated the predominance of genotypes 1 (73.3 %) and 3 (26.7 %). Multivariate analysis showed an association of HCV infection with tattoos, shared use of paraphernalia, daily cocaine use, and a long history of cocaine use. The epidemiological aspects of HCV infection among cocaine users presented here should serve as an incentive for the establishment of a program of hepatitis C prevention and control by the local public-health authorities in the Amazon.

PMID: 23408127



The sharing of drug paraphernalia is currently the principal form of transmission of HCV infection worldwide. It is estimated that more than 60 % of the new cases of HCV infection recorded each year are related to the use of illicit drugs (1). The prevalence of HCV infection in illicit drug users varies from 10% to 95%, reflecting the presence or absence of specific risk factors, such as the history of drug use, sharing of drug paraphernalia, and the type of consumption: inhaled or injected. In Brazil, the prevalence of HCV infection is around 1.4%. In addiction, significant differences in prevalence of infection and distribution of HCV genotypes among Brazilian regions are reported. The Brazilian Amazon (northern Brazil) stands out with the highest prevalence of infections and higher frequency of genotype 1 (2).

This study is the first report of HCV infection exclusively done by cocaine users in the Brazilian Amazon. It was possible to detect a high prevalence of HCV infection, with a predominance of genotype 1. This fact becomes more relevant it is observed that all cocaine users surveyed consumed preferably non-injecting cocaine. Occasionally, some cocaine users who had sufficient financial resources consumed injecting cocaine at least once in their lifetime. Likely, this occasional use of injecting cocaine associated with sharing of paraphernalia during drug use is responsible for the spread of HCV among injection cocaine users (ICUs). However, doubt remains. The prevalence of HCV infection among non-injection cocaine users (NICUs) is high. How is HCV infection being transmitted among NICUs?

This study indicated four risk factors for HCV infection. Having a tattoo was associated with HCV infection. Commonly, the tattoo is identified as a risk factor for HCV infection in illicit-drug users. This shows the lifestyle of illicit-drug users, which could include greater exposure to HCV. Furthermore, as an aggravating location, it is common in parks, beaches and other public places unprofessional people doing tattoos with inadequate equipment at reduced prices (Figure 1).

The daily use of drugs, paraphernalia sharing during drug use, and a long history of drug use were also associated with HCV infection in NICUs. Although difficult, there is a possibility of HCV transmission through sharing of paraphernalia during drug use. This is because most users consume oxi (term informed by cocaine users). The oxi is made from leftovers of cocaine paste, cooked with variable amounts of gasoline or kerosene and “raw” (“virgem”) lime (CaO) (3). However, analysis of the chemical profile of the oxi indicated that it is a possible way of adulterated forms of cocaine usually sold in Brazil (4). According to cocaine users, the oxi is smoked using a pipe or perforated aluminum can that burn the stones (Figure 2). In some cases, it is crushed and used with tobacco cigarettes or marijuana, or powder, which is sucked through the nose. But what should be highlighted is that often the consumption of oxi causes burns of lips and nostrils.

Few studies have reported the presence of HCV-RNA in the nasal secretions of non-injecting drug users, indicating a possible alternative route for the transmission of the virus – the sharing of the paraphernalia used to consume these drugs (5,6). One hypothesis to account for these cases involves intranasal transmission of HCV via contaminated implements, requiring two primary virological preconditions: the presence of blood and HCV in the nasal secretions of intranasal drug users, and the transfer of blood and HCV from the nasal cavity onto sniffing implements, which are often shared by intranasal drug users. Although complex, this viral transmission is possible. Some studies to verify this possibility are ongoing in Brazilian state of Pará (7) and, so far, this question has not been solved. Moreover, epidemiological studies with other viruses (HBV, HIV, HTLV-1/2) are being conducted in the population of cocaine users in the Brazilian Amazon.

Figure 1Figure 1. Making tattoos in public squares in the state of Pará.

Figure 2Figure 2. Cocaine seized by police in the state of Pará.



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4. da Silva Junior RC, Gomes CS, Goulart Júnior SS, et al. Demystifying “oxi” cocaine: Chemical profiling analysis of a “new Brazilian drug” from Acre State. Forensic Sci Int 2012, 221(1-3):113-119.

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6. Fischer B, Powis J, Firestone Cruz M, et al. Hepatitis C virus transmission among oral crack users: viral detection on crack paraphernalia. Eur J Gastroenterol Hepatol 2008, 20(1):29-32.

7. Oliveira-Filho AB, Sawada L, Pinto LC, et al.: Epidemiological aspects of HCV infection in non-injecting drug users in the Brazilian state of Pará, eastern Amazon. Virol J 2014 11(1):38.


Acknowledgements: This study was supported by PN-DST/AIDS/Hepatites (CSV298/2006), and PPSUS/ FAPESPA (PPSUS-PA:25/2007). A. B. Oliveira-Filho received scholarship from CNPQ (141928/2008-5) for the development of this research.



Aldemir B. Oliveira-Filho. Ph.D. Professor and Chair.

Institute for Coastal Studies, Federal University of Pará.

Alameda Leandro Ribeiro, s/n. Aldeia. 68600-000. Bragança PA, Brazil.


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