Prevalence of hepatitis B and hepatitis C markers in alcoholics with and without clinically evident hepatic cirrhosis

Evaluation of hepatitis A, B, and C serology in patients with cirrhosis and intensive alcohol consumption

OBJECTIVE

The objective of this study was to evaluate the serology of hepatitis A, B, and C in patients with cirrhosis and intensive alcohol consumption.

METHODS

We retrospectively reviewed the viral serology results of 817 patients with cirrhosis and intensive alcohol consumption who presented to the Gastroenterology Clinic of Atatürk Training and Research Hospital of Izmir Katip Çelebi University between April 2008 and December 2017. The diagnosis of cirrhosis was based on clinical and biochemical evaluations and imaging results. Patients consuming absolute alcohol 40 g/day for >10 years were included and those who quit drinking ≥15 years ago were excluded.

RESULTS

Of all the patients, 806 (98.7%) were positive for anti-HAV IgG, 159 (19.5%) for HBsAg, and 32 (3.9%) for anti-HCV. Genotyping was performed in 13 patients. Genotype 1 was detected in 10 patients (1a, one patient; 1b, nine patients) and genotype 3 in three patients. Of the patients with HBV, 10.0% had HBeAg and 7.6% had anti-delta. One-hundred and two (12.5%) patients had HCC, and of these, six (5.9%) were HCV-positive and 53 (52.0%) were HBsAg-positive.

CONCLUSION

Patients with cirrhosis and intensive alcohol consumption have an increased hepatitis B and C prevalence. Patients with chronic viral hepatitis with alcohol habit are at a higher risk for HCC. Therefore, patients with cirrhosis and intensive alcohol consumption should be screened for hepatitis B and C.

Impact of alcohol consumption among patients in hepatitis C virus treatment

ABSTRACT BACKGROUND: Recent studies have questioned the recommendation of abstinence from alcohol for at least 6 months for alcoholic patients to be treated for hepatitis C. OBJECTIVE: The present study aimed to assess the impact of alcohol consumption among patients undergoing hepatitis C treatment. METHODS: In this cross-sectional study, 121 patients [78 (64.5%) men; 28-70 years] were evaluated. They were divided as follows: patients who consumed <12 g of ethanol/day throughout life (Group 1), 12-59 g/day (Group 2) and ≥60 g/day (Group 3). Patients were treated with pegylated-interferon plus ribavirin. RESULTS: These three groups could not be distinguished in terms of the severity of liver fibrosis and frequency of HCV genotype-1 infection. In Group 3, treatment discontinuation (32.4%) was higher than in the Group 1 (9.4%) or Group 2 (0%), it was higher among patients who drank during treatment (66.7% vs 21.4%) and among those who had not been abstinent for at least 6 months (72.7% vs 15.4%). Moderate alcohol drinkers showed good adherence and did not discontinue the treatment. The frequencies of sustained viral response among patients in Group 3 (44.4%) were similar to those in Group 1 (61%) and Group 2 (68.4%). CONCLUSION: Heavy drinkers more often discontinued treatment for hepatitis C, but those that received this treatment had acceptable sustained viral response rates. These results suggest that heavy drinkers should not be systematically excluded from the treatment, but they should be monitored to avoid drinking and abandoning treatment, mainly those who have not been abstinent for at least 6 months.

Viral hepatitis in alcohol-dependent inpatients: prevalence, risk factors, and treatment uptake

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.

Seroprevalence of hepatitis A immunity among brazilian adult patients with liver cirrhosis: is HAV vaccination necessary?

BACKGROUND

Patients with chronic liver disease have a higher risk of fulminant hepatitis when infected with hepatitis A virus, and vaccination of these patients against such infection is recommended. In Brazil, mainly in the South and Southeast regions, the epidemiology of hepatitis A (HA) has shifted from high to intermediate endemicity, which would have implication on policy of HA vaccination for these populations.

OBJECTIVE

To verify the prevalence of HA immunity in adult patients with liver cirrhosis (LC), in Uberlândia MG, a city of Southeastern Brazil.

METHODS

Between December 2005 and December 2006, 106 patients with LC were consecutively evaluated. In addition, 75 individuals without LC or alcoholism were evaluated (control group - CG).

RESULTS

Total anti-HAV (ELISA methods) was positive in 104 (98.1%) patients with LC (82 men, 24 women; mean age, 53.3 ± 11.9 years) and in 74 (98.7%) individuals of the CG (55 men, 20 women; mean age, 47 ± 11.6 years), p > 0.05.

CONCLUSIONS

For patients with chronic liver disease, in the geographic regions and age groups evaluated, routine vaccination against hepatitis A is not recommended. Moreover, the serum determination of total anti-HAV, used to assess immunity, is five times cheaper than vaccination against hepatitis A and, for this reason, should precede vaccination.

[Response to hepatitis B vaccine in alcoholics without clinically evident liver cirrhosis]

BACKGROUND

Alcoholics have higher prevalence of hepatitis B virus (HBV) infection than non-alcoholics and such fact may influence in the development of liver cirrhosis and/or hepatocellular carcinoma.

AIM

To evaluate the response to hepatitis B vaccine in alcoholics without liver cirrhosis.

METHODS

Twenty male alcoholics with mean age of 46.6 +/- 10.9 years were vaccinated; they ingested more than 80 g of ethanol/day for more than 10 years. As control group 40 male non-alcoholics with mean age of 37.8 +/- 9.7 years were also vaccinated. No serological evidence of contact with HBV, hepatitis C virus or human immunodeficiency virus was found among the subjects of both groups. The vaccine Euvax B (20 microg) was administered intramuscularly into the deltoid area at 0, 1 and 6 months. Serum anti-HBs were determined after one month of the last dose. Levels <10 mUI/mL were considered as non-response, between 10 and 99 mUI/mL as seroconversion, and > or = 100 mUI/mL as seroprotection.

RESULTS

No significant difference was found between alcoholics and controls, respectively, in the frequency of non-response (35.0% vs 32.5%), seroconversion (15.0% vs 15.0%) and seroprotection (50.0% vs 52.5%). Among responders, mean levels of anti-HBs in alcoholics (511 +/- 448 mUI/mL) were similar to the controls (696 +/- 410 mUI/mL). No negative interference on the response was associated with the body mass index, tabagism, being drinking or concurrent chronic pancreatitis without pancreatic insufficiency.

CONCLUSIONS

Male alcoholics without liver cirrhosis had similar frequency and serum levels of anti-HBs to the non-alcoholics in response to HBV vaccination.

Psychiatric and substance use disorders in individuals with hepatitis C: epidemiology and management

Hepatitis C virus (HCV) infection is a major health concern in the US as well as in other countries worldwide. Treatment issues and disease management strategies are complicated by the extremely high rate of psychiatric and substance use disorders in those who have HCV. The majority of new and existing cases of HCV are related to injection drug use and, in this population, the prevalence of psychiatric comorbidity is high. Optimally, all patients with HCV should be screened for psychiatric and substance use disorders before initiation of antiviral therapy. If a patient screens positive, he or she should be referred to a mental healthcare provider or addiction specialist, assessed for the presence of a psychiatric or substance use disorder, and appropriately treated prior to initiation of antiviral (i.e. interferon) therapy. Although interferon-based therapies can lead to severe neuropsychiatric adverse effects, including in rare instances suicide, evidence suggests that many patients with comorbid psychiatric and substance use diagnoses can be treated safely and effectively using comanagement strategies. However, most patients with HCV are not treated with antiviral therapy. Therefore, we must expand our definition of HCV 'treatment' to include treatment of the comorbid psychiatric and substance use disorders that accompany HCV infection and precede antiviral therapy. This paper reviews the epidemiology and management of psychiatric and substance use disorders in patients with HCV, the issue of psychiatric and substance use disorders as contraindications for antiviral therapy, and current treatment strategies for HCV patients with these comorbid conditions.

[Prevalence of hepatitis B and hepatitis C viruses in different counties of Catalonia, Spain: cross-sectional study]

BACKGROUND

There are few data available in our community regarding the prevalence of hepatitis B (HBV) and hepatitis C (HCV) virus infection in the general population.

MATERIAL AND METHOD

The aim of this study was to determine the prevalence and serologic characteristics of HBV and HCV in Catalonia. For this purpose, HBsAg and anti-HCV were assessed in serum aliquots obtained from a sample of 2194 individuals, who were chosen at random out from different Catalonian counties. In those cases in which any of the markers were positive, the following analyses were performed afterwards: serum transaminases, HBV-DNA detection by PCR (in HBsAg positives) and HCV-RNA detection by PCR and genotypes (in antiHCV positives). All subjects yielding positive results were interviewed in order to determine possible risk factors.

RESULTS

HBV prevalence was 1.69% (95% CI, 1.62-1.76) and that of HCV was 2.64% (95% CI, 2.53-2.75). HCV prevalence increased with age (1.7% in younger than 50 years and 3.6% in older than 50 years, p < 0.01), but not that of HBV. Only a small proportion (12.1%) of HBV carriers had detectable HBV-DNA levels. On the contrary, quite an important proportion of HCV carriers (68.6%) had detectable HCV-RNA levels. Predominant HCV genotype was 1 (79.3%). Transaminases levels were within normal limits in many HBV and HCV carriers (70.9 and 60%, respectively).

CONCLUSIONS

Prevalence of HBV and HCV in Catalonia was 1.69% and 2.64%, respectively. Most HCV carriers had positive serum HCV-RNA, whereas serum HBV-DNA was negative in most HBV carriers

Prevalence of human immunodeficiency virus infection in alcoholics

To verify the prevalence of infection by human immunodeficiency virus (HIV) in alcoholics we studied 131 alcoholic patients (119 males and 12 females) with a mean age of 44.3 +/- 10.8 years. Serum samples were collected from this group and analysed, by ELISA, for antibodies against HIV as well as for serological markers for hepatitis B virus (HBV) and hepatitis C virus (HCV). As we have previously described, we found a high prevalence of HBV (26.4%) and HCV (4.2%) markers as compared to the prevalence of these markers in samples of normal blood donors from Uberlândia's Hemocentro Regional, which are 4% and 0.4%, respectively. Of the 131 patients, four (3%) had antibodies against HIV, three (75%) of which were injecting drug users (IDU). In the HIV-negative group, only one patient was an IDU. The prevalence of HIV in our population, according to data from the city's Health Secretary, varies from 3.1% to 6.2%. We conclude that, at least for the moment, alcoholism per se, did not constitute an important risk factor for HIV infection. However, acquired immunodeficiency syndrome is a rather recent disease as compared to hepatitis B and C and, as the transmission routes are similar for HIV and hepatitis viruses, an increase in the incidence of HIV infection in alcoholics may be just a question of time.