Markers for Hepatitis A, B and C in Methadone Maintained Patients: an Unexpectedly High Co-infection with Silent Hepatitis B

Overview

Journal Addiction

Specialty Psychiatry

Date 2008 Mar 15

PMID 18339114

Citations 9

Authors

Gavin Bart

Paola Piccolo

Linqi Zhang

Ira Jacobson

Robert A Schaefer

Mary Jeanne Kreek

Affiliations

Soon will be listed here.

Abstract

Aims: To determine the prevalence of hepatitis A, B and C viruses in patients attending a methadone maintenance clinic in New York City.

Design: Cross-sectional.

Setting: The Adult Services Clinic of Weill Cornell Medical College, an urban hospital-affiliated methadone program.

Participants: Former heroin addicted adults (n = 103) on methadone maintenance therapy.

Measurements: Markers for hepatitis A virus [HAV immunoglobulin M (IgM) and imunoglobulin G (IgG)], hepatitis B [hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb)] and hepatitis C virus (HCVAb). Serum alanine aminotransferase (ALT) and quantitative HCV RNA were also obtained. Qualitative detection of HBV DNA and HCV genotype were obtained in a subset of subjects.

Findings: More than 40% of subjects had markers for all three viruses. HCVAb was the most prevalent (83.5%), followed by HBcAb (65.0%), HAV IgG (46.1%) and HBsAb (41.1%). Hepatitis C RNA was detected in 70.6% of HCVAb positive subjects. While no subject had HBsAg, HBV DNA was detected in 26.4% of subjects who underwent this measure; all (n = 20) had HBcAb as their only HBV marker. The presence of HBV DNA did not influence ALT. Subjects with HCV RNA had higher ALTs than those without HCV RNA.

Conclusions: Most methadone-maintained subjects had at least one marker for viral hepatitis, with 41.8% having markers for HAV, HBV and HCV. A quarter of subjects had silent HBV infection, defined as the presence of HBV DNA in the absence of HBsAg. These subjects should be considered infectious and pose a public health risk.

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