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Bipolar Disorders

Hepatitis C testing and infection rates in bipolar patients with and without comorbid substance use disorders

Authors

  • Annette M Matthews,

    1. Northwest Hepatitis C Resource Center,
    2. Behavioral Health and Clinical Neurosciences Division, Portland VA Medical Center
    3. Department of Psychiatry, Oregon Health and Science University, Portland
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  • Marilyn S Huckans,

    1. Northwest Hepatitis C Resource Center,
    2. Behavioral Health and Clinical Neurosciences Division, Portland VA Medical Center
    3. Department of Psychiatry, Oregon Health and Science University, Portland
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  • Aaron D Blackwell,

    1. Department of Anthropology, University of Oregon, Eugene
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  • Peter Hauser

    1. Northwest Hepatitis C Resource Center,
    2. Behavioral Health and Clinical Neurosciences Division, Portland VA Medical Center
    3. Department of Psychiatry, Oregon Health and Science University, Portland
    4. Department of Anthropology, University of Oregon, Eugene
    5. Department of Behavioral Neurosciences, Oregon Health and Science University
    6. JENS Laboratory, Portland VA Medical Center
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  • AMM was an American Psychiatric Association Bristol‐Meyers Squibb Fellow in Public and Community Psychiatry when this paper was written. PH receives research support from the Veterans Affairs Merit Review Program, the National Institute for Mental Health, GlaxoSmithKline, Hoffman LaRoche and AstraZeneca Pharmaceuticals, and serves on the speakers bureau for Abbott Laboratories, AstraZeneca Pharmaceuticals, Bristol‐Myers Squibb Co., GlaxoSmithKline, and Janssen Pharmaceuticals. MSH and ADB have no reported conflict of interest.

Corresponding authors: Peter Hauser, MD, Annette M Matthews, MD, Portland VA Medical Center, 3710 SW US Veteran Hospital Road, PO Box 1035 (V3MHC), Portland, OR 97202, USA.
Fax: +1 503 721 1051;
e‐mail: peter.hauser2@med.va.gov, annette.matthews@med.va.gov

Abstract

Objectives:  To determine and compare hepatitis C (HCV) screening and testing rates among four groups: those with (i) bipolar disorder [BD group (history of BD but no substance use disorder)]; (ii) substance use disorders [SUD group (history of SUD but no BD)]; (iii) co‐occurring disorders [DD group (history of both BD and an SUD)]; and (iv) a control group (no history of either bipolar disorder or substance use disorder). Our hypothesis was that HCV antibody testing rates and HCV prevalence would be higher in the BD, SUD, and DD groups than the control group.

Methods:  Data were retrospectively collected on 325,410 patients seen between 1998 and 2004 within facilities and clinics of the Veterans Integrated Service Network (VISN) 20 Northwest Veterans Health Care Administration from electronic medical records. HCV screening and prevalence rates were compared between the BD, SUD, DD, and control groups. Odds ratios and relative risks were determined and compared between groups.

Results:  Patients in the BD, SUD, and DD groups had been tested at a higher rate than controls and were at increased risk for HCV infection compared with controls. These high‐risk groups had a 1.31‐fold, 4.86‐fold, and 5.46‐fold increase in the relative risk of HCV infection, respectively. Overall, compared to the control group, the relative risk of a patient having HCV if he or she had BD (with or without an SUD) was 3.6.

Conclusions:  Patients with BD and comorbid SUD had an over fourfold increase in relative risk for HCV than our control group and a similar risk as patients in our SUD group. Furthermore, even if bipolar patients did not have a comorbid SUD (the BD group), their relative risk of HCV was significantly higher than that of the control group. This suggests that patients with BD, particularly those with a comorbid SUD, should be screened and tested for HCV.

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