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Viral Hepatitis in Alcohol-Dependent Inpatients: Prevalence, Risk Factors, and Treatment Uptake

Schmidt, Christiane Sybille MSc; Schön, Daniela PhD; Schulte, Bernd MSc; Lüth, Stefan MD; Polywka, Susanne MD; Reimer, Jens MD

doi: 10.1097/ADM.0b013e3182a50817
Original Research

Objectives: Most epidemiological literature on the prevalence of viral hepatitis in alcohol-dependent patients is based on older data. This study aimed to provide current estimates and an assessment of risk factors. We further investigated whether the initiation of antiviral hepatitis C virus (HCV) treatment is feasible after detoxification.

Methods: We assessed serological markers for hepatitis B virus (HBV) and HCV infection and liver enzyme levels (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase) in a sample of 463 inpatients in a tertiary care hospital, fulfilling International Classification of Diseases, Tenth Revision criteria for alcohol dependence. A subsample of 141 patients was interviewed on addiction history and risk factors for HCV acquisition. All patients with an indication for antiviral treatment were followed up.

Results: Compared with that in the general population, we found an elevated anti-HCV prevalence in alcohol-dependent patients (5.2%; 95% confidence interval, 3.2%-7.2%), whereas anti-Hbc immunoglobulin G prevalence (8.3%; 95% confidence interval, 5.7%-10.8%) corresponded to normal rates. Liver enzyme levels significantly differed between patients with chronic, past/remitted, or no HCV infection. On an observational level, a history of injection drug use or nonprofessional tattooing emerged as potential risk factors. In 1 of 10 patients, antiviral therapy was initiated. This 1 patient achieved the end-of-treatment response after extended rapid virological response, despite continuous alcohol consumption.

Conclusions: The elevated HCV infection rates in our sample and the higher levels of fibrosis biomarkers in those with positive polymerase chain reaction corroborate previous findings and emphasize the importance of HCV screening in this population, particularly if further risk factors like injection drug use are given. Factors influencing treatment reluctance and conditions that may enhance the feasibility of antiviral treatment in alcohol-dependent patients should be subject of further research.

From the Centre for Interdisciplinary Addiction Research (CSS, DS, BS, JR), Department of Medicine I (SL), and Department of Medical Microbiology, Virology and Hygiene (SP), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Send correspondence and reprint requests to Christiane Sybille Schmidt, Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany. E-mail: christiane.schmidt@uke.de.

Supported by an unrestricted educational grant from Roche Pharma AG, Grenzach Wyhlen, Germany.

Roche Pharma had no role in the generation or approval of the manuscript.

The authors declare no conflicts of interest.

Received January 30, 2012

Accepted July 14, 2013

© 2013 American Society of Addiction Medicine