Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co-infection with silent hepatitis B

Authors: Bart, Gavin¹; Piccolo, Paola²; Zhang, Linqi; Jacobson, Ira³; Schaefer, Robert A.³; Kreek, Mary Jeanne

Source: Addiction, Volume 103, Number 4, April 2008 , pp. 681-686(6)

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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.

Keywords: Hepatitis B; hepatitis C; methadone maintenance; occult infection; viral hepatitis

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1360-0443.2008.02151.x

Affiliations: 1: The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, NY, USA, 2: Department of Medicine, Fatebenefratelli Hospital Isola Tiberina, Rome, Italy, 3: Gastroenterology and Hepatology, Weill Cornell Medical College, NY, USA

Publication date: 2008-04-01

Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co-infection with silent hepatitis B

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