Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co-infection with silent hepatitis B
Article first published online: 13 MAR 2008
© 2008 The Authors
Volume 103, Issue 4, pages 681–686, April 2008
How to Cite
Bart, G., Piccolo, P., Zhang, L., Jacobson, I., Schaefer, R. A. and Kreek, M. J. (2008), Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co-infection with silent hepatitis B. Addiction, 103: 681–686. doi: 10.1111/j.1360-0443.2008.02151.x
- Issue published online: 13 MAR 2008
- Article first published online: 13 MAR 2008
- Submitted 11 July 2007; initial review completed 23 October 2007; final version accepted 31 December 2007
- Hepatitis B;
- hepatitis C;
- methadone maintenance;
- occult infection;
- viral hepatitis
Aims To determine the prevalence of hepatitis A, B and C viruses in patients attending a methadone maintenance clinic in New York City.
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.