Thursday, September 6, 2012

Injection drug use, blood transfusions biggest risk factors for hepatitis C

Injection drug use, blood transfusions biggest risk factors for hepatitis C

Allison RD. J Infect Dis. 2012;206:654-661.
  • September 6, 2012
Injection drug use and receiving a blood transfusion before 1991 were found to be the main risk factors for acquiring hepatitis C, according to study findings.

The study, which began enrollment in August 1990, included 738 volunteer blood donors who tested positive for hepatitis C antibodies. Confirmation testing was done using third-generation recombinant immunoblot assays (RIBA). The donors were interviewed by a physician about their histories, including illicit drug use. Liver biopsy specimens were taken from 185 patients with RIBA-confirmed hepatitis C.

Among the 738 volunteers, 469 had hepatitis C confirmed using RIBA. On multivariate analysis, the most significant risk factor was injection drug use, with an OR of 35 (95% CI, 10.4-218), followed by receiving a blood transfusion before 1991, with an OR of 9.9 (95% CI, 5.6-18.3). Intranasal cocaine use was also a significant risk factor, with an OR of 6.4 (95% CI, 3.8-11.2). In a subset of intranasal cocaine users who denied injection drug use and blood transfusion, the OR was 8.5 (95% CI, 4.9-15.1).

Among those who were confirmed with RIBA, 384 had hepatitis C virus RNA. From these patients, 33% of liver biopsy specimens showed no fibrosis, 52% had mild fibrosis, 12% had bridging fibrosis and 2% had cirrhosis.

“Identification of silent HCV carriers and access to treatment remain major public health hurdles, but among treated subjects, the number who will not achieve a sustained virologic response has been reduced dramatically with the recent licensure of protease inhibitors,” the researchers wrote.

“Since the majority of HCV-infected individuals will not be treated in the near term, continued long-term follow-up is critically needed to provide better estimates of clinical and histologic outcomes after 3 or more decades of HCV infection."

Disclosure: The researchers report no relevant financial disclosures.

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