Results of a study published in Clinical Infectious Diseases showed a novel association between the use of low dead space syringes with fixed needles and a decreased risk for hepatitis C virus (HCV) infection among people who inject drugs (PWID).

Investigators analyzed responses to the unlinked anonymous monitoring (UAM) survey, an annual cross-sectional biobehavioral survey of individuals with a history of injection drug use. Participants were enrolled at specialist harm reduction services located across England, Wales, and North Ireland. Eligible participants included those who reported injection drug use within the previous month, tested negative for HCV antibodies, and had an available HCV RNA test result.  

The investigators calculated the percentage of self-reported use of syringes with either detachable or attached/fixed needles within the past month. They created a binary variable for participants who reported exclusive use fixed low dead space syringes (LDSS; ie, full use of syringes with fixed needles) and those who reported less than 100% use of fixed LDSS (ie, any use of syringes with detachable needles). In addition, logistic regression models were used to estimate the unadjusted and adjusted associations between 100% fixed LDSS use and recent primary HCV infection compared with less than 100% fixed LDSS use.

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Of 1465 participants included in the final analysis, 63.8% reported 100% fixed LDSS use, 25.5% reported exclusive use of syringes with detachable needles, and 10.7% reported use of both types of syringes. The mean patient age was 37.3 years, 26.2% were women, and 33 (2.3%) had a recent primary HCV infection.

Fewer recent HCV infections were found among patients who reported exclusive use of fixed LDSS compared with those who reported use of syringes with detachable needles (1.3% vs 3.8%). Exclusive fixed LDSS use was associated with a 76% decrease in the odds of having a recent HCV infection compared with the use of syringes with detachable needles (adjusted odds ratio, 0.24; 95% CI, 0.08 to 0.67; P =.007).

The study was limited by its observational design, the lack of longitudinal follow-up to track newly diagnosed HCV infections, and its dependance on self-reported data for behavioral and intervention-related factors may have introduced bias.

Despite these limitations, the investigators suggested, “given this evidence…, [harm reduction] programs should encourage PWID to use fixed LDSS to minimize their risk [for] acquiring HIV and HCV infection and provide syringes with detachable needles that minimize the dead space associated with that type of syringe.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Trickey A, Croxford S, Emanuel E, et al. The effectiveness of low dead space syringes for reducing the risk of hepatitis C virus acquisition among people who inject drugs – findings from a national survey in England, Wales, and Northern Ireland. Clin Infect Dis. Published online February 20, 2022. doi:10.1093/cid/ciac140  

This article originally appeared on Infectious Disease Advisor