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Logemann S, Blinkhorn R. Acute Viral Hepatitis Due to Co-infection With Hepatitis A and Hepatitis B in an Intravenous Drug User. Cureus 2023; 15:e37179. [PMID: 37168197 PMCID: PMC10166325 DOI: 10.7759/cureus.37179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Injection drug users are at high risk of contracting human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) due to parenteral exposure. Hepatitis A virus (HAV) is classically thought to be transmitted through the fecal-oral route, but injection drug use is increasingly recognized as a risk factor. It is well documented that there is a high prevalence of total antibodies to HAV in injection drug users, although there is limited data about the prevalence of acute HAV in injection drug users. Acute viral hepatitis is most often due to HAV, HBV, or hepatitis E virus (HEV), and it is rare to have acute co-infection with these viruses. We report a case of acute viral hepatitis due to co-infection with both HAV and HBV in an injection drug user.
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Hepatitis A virus infection associated with cannabis use. Can Commun Dis Rep 2017; 43:245-246. [DOI: 10.14745/ccdr.v43i11a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Fisher DG, Reynolds GL, Jaffe A, Perez MJ. Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California. J Addict Dis 2007; 25:25-32. [PMID: 16785216 DOI: 10.1300/j069v25n02_04] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV.A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high.
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Affiliation(s)
- Dennis G Fisher
- Center for Behavioral Research and Services, California State University, Long Beach, CA 90813, USA.
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Spada E, Genovese D, Tosti ME, Mariano A, Cuccuini M, Proietti L, Giuli CD, Lavagna A, Crapa GE, Morace G, Taffon S, Mele A, Rezza G, Rapicetta M. An outbreak of hepatitis A virus infection with a high case-fatality rate among injecting drug users. J Hepatol 2005; 43:958-64. [PMID: 16143420 DOI: 10.1016/j.jhep.2005.06.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 06/10/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyses. METHODS We conducted an epidemiological investigation, including a case-control study, to identify the source and the modes of HAV transmission. Hepatitis B and C (HCV) viruses and human immunodeficiency virus (HIV) coinfections were clinically analysed. Sequence analysis of the VP1/2A junction of the HAV isolates was also performed. RESULTS Of the 47 symptomatic cases, 35 were IDUs. The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95% confidence interval: 1.3-29.9). Of the cases, 58% were anti-HCV positive and 4.7% anti-HIV positive. Three individuals died of acute liver failure: 2 were HCV-coinfected alcohol abusers, with underlying liver cirrhosis; 1 was HCV/HIV-coinfected. HAV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and IIIA (7 cases) were detected. CONCLUSIONS HAV was probably transmitted through the fecal-oral route, although parenteral transmission cannot be excluded. The high fatality rate was probably due to severe underlying liver damage. The occurrence of this outbreak highlights the need for routine HAV vaccination for IDUs.
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Affiliation(s)
- Enea Spada
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Clinical Epidemiology Unit, Viale Regina Elena 299, 00161 Rome, Italy.
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Roberts RJ, Palmer SR. Exposure to school children as a risk factor in a community outbreak of hepatitis A in young adults: a case control study. Epidemiol Infect 2005; 134:803-7. [PMID: 16316491 PMCID: PMC2870453 DOI: 10.1017/s0950268805005625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2005] [Indexed: 11/06/2022] Open
Abstract
To investigate risk factors during a community outbreak of hepatitis A we carried out a case- control study of 35 cases and 49 matched controls using an interviewer-administered questionnaire on clinical history, travel, household details including domestic toilet facilities, infectious contacts, and food history. Of 99 cases notified in the city during the outbreak year, 50 (51%) were young adults age 15-34 years. Hepatitis A infection was independently associated with household contact with a case (P=0.0005), and sharing a household with children in primary school (OR 3.4, 95% CI 1.2-9.5, P=0.008) with risk increasing with number of primary-school pupils in the household (chi(2) for linear trend 6.47, P=0.01). We concluded that in a population with a low prevalence of hepatitis A, adults who live in the same household as primary-school-age children are at increased risk of acquiring the infection during community outbreaks.
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Affiliation(s)
- R J Roberts
- National Public Health Service, Preswylfa, Mold, Flintshire, UK.
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Vong S, Fiore AE, Haight DO, Li J, Borgsmiller N, Kuhnert W, Pinero F, Boaz K, Badsgard T, Mancini C, Nainan OV, Wiersma S, Bell BP. Vaccination in the county jail as a strategy to reach high risk adults during a community-based hepatitis A outbreak among methamphetamine drug users. Vaccine 2005; 23:1021-8. [PMID: 15620475 DOI: 10.1016/j.vaccine.2004.07.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 07/19/2004] [Accepted: 07/26/2004] [Indexed: 01/13/2023]
Abstract
Illicit drug use (IDU) is an important risk factor for hepatitis A, but implementing vaccination programs among drug users is difficult. During January 2001-July 2002, 403 hepatitis A cases were reported in Polk County, Florida; 48% were drug users and of these, 80% were recently in jail. To assess the county jail as a potential vaccination venue, we interviewed 280 inmates and conducted a serologic survey during July--August 2002. Of these, 227 (81%) reported a past IDU history. Previous HAV infection was found in 33%. In communities with illicit drug users at risk for hepatitis A and who are frequently jailed, vaccination programs in jails could be an important component of a community-based strategy to control hepatitis A outbreaks among illicit drug users.
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Affiliation(s)
- Sirenda Vong
- Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop D-66, Atlanta, GA 30333, USA.
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Brunet A, Grabar S, Blanche P, Héripret-Fredouille L, Spiridon G, Calboreanu A, Rollot F, Launay O, Sicard D, Salmon-Céron D, Abad S. Prévalence et facteurs de risque de l'hépatite A au sein d'une population de patients infectés par le virus de l'immunodéficience humaine. Med Mal Infect 2005; 35:73-81. [PMID: 15780896 DOI: 10.1016/j.medmal.2004.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 09/07/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are common risk factors between hepatitis A virus (HAV) and human immuno deficiency virus (HIV) infections. OBJECTIVES We tried to evaluate if HIV-infected patients could be at risk for HAV. More over, HAV could worsen prognosis of HIV infection and HAV vaccination was then to be considered. Thus we assessed the prevalence and risk factors of HAV infection in an HIV-infected population. PATIENTS AND METHODS Seroprevalence and risk factors for HAV were studied among 154 HIV-positive patients followed in a Parisian hospital (mean age: 42 years, male patients: 70.8%, female patients: 29.2%). They were screened for HAV antibodies and answered a questionnaire on risk factors for HAV and means of HIV contamination. RESULTS The global prevalence was 72.7% [IC95%: 65.7-79.7]. We excluded patients who were born in highly endemic areas where seroprevalence reached 60% [IC95%: 51.2-70]. The HAV seroprevalence was almost 100% in migrants from highly endemic countries and for those born before 1946. The multivariate analysis showed that risk factors were the geographic origin [OR=20.88; IC95%: 2.40-181], age [OR = 2.33; IC95%: 1.24-4.39], and hemophilia [OR = 13.78; IC95%: 1.34-141]. CONCLUSION Our results suggest that a screening test for HAV antibodies should be performed before vaccination, especially in HIV-infected patients born after 1946 or in non-endemic countries.
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Affiliation(s)
- A Brunet
- Service de médecine interne 2, hôpital Cochin-Saint-Vincent-de-Paul, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
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Syed NA, Hearing SD, Shaw IS, Probert CS, Brooklyn TN, Caul EO, Barry RE, Sarangi J. Outbreak of hepatitis A in the injecting drug user and homeless populations in Bristol: control by a targeted vaccination programme and possible parenteral transmission. Eur J Gastroenterol Hepatol 2003; 15:901-6. [PMID: 12867801 DOI: 10.1097/00042737-200308000-00011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To study the use of hepatitis A virus (HAV) vaccination in controlling an outbreak of HAV in inner-city Bristol among injecting drug users (IDUs). To study whether hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infection increases morbidity. DESIGN Community-based cohort study. SETTING Avon Health Authority area, UK. PARTICIPANTS All laboratory-confirmed cases of HAV infection notified in 2000. INTERVENTION Administration of a targeted vaccination, education and liaison programme. MAIN OUTCOME MEASURES Number of cases of HAV before and after introduction of HAV vaccination programme. Mortality and number of patients requiring hospital admission. Association of HCV and HBV co-infection with hospital admission. RESULTS Ninety cases of HAV were reported in the first 6 months of 2000, of whom a substantial number were IDUs and/or inner-city hostel residents. In the second 6 months of 2000, following the introduction of a vaccination programme among homeless people, hostel residents, and IDUs, the number of HAV cases fell to 33. Sixteen patients had evidence of HCV co-infection. No patient had chronic HBV infection. Two patients died as a result of HAV, and two subsequently died from drug misuse. Fifty-six per cent of HCV-co-infected patients required admission to hospital compared with 28% non-HCV-co-infected patients. CONCLUSIONS This is the first reported successful use of vaccination to control an outbreak of HAV in a population of IDUs and to prevent transmission to the wider population. HCV co-infection appears to increase the severity of HAV illness, as demonstrated by increased incidence of hospital admission.
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Affiliation(s)
- Naveed A Syed
- Department of Public Health, Avon Health Authority, Bristol, UK.
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Abstract
Hepatitis is a common disorder with diverse etiology. Hepatitis can be classified as acute when duration is short and as chronic when it lasts more than 6 months. It can also be suspected to be chronic because of its cause. When evaluating a patient with hepatitis, investigation for viral etiologies is usually the first step, however it is important not to forget the other possibilities of drug- or chemical-related injury, as well as the multiple immune, metabolic and toxic causes of hepatitis. In this article, we have dedicated the larger part of our discussion to viral etiologies. There has been enormous progress over the past few years in the management of viral hepatitis, especially of viral hepatitis B and C. In this article, we discussed current therapeutic options in the management of these relatively common disorders and provided some recommendations in preventing transmission of these infections.
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MESH Headings
- Acute Disease
- Adult
- Antiviral Agents/therapeutic use
- Disease Transmission, Infectious/prevention & control
- Hepatitis Antibodies/immunology
- Hepatitis B/drug therapy
- Hepatitis B/virology
- Hepatitis C/drug therapy
- Hepatitis C/virology
- Hepatitis, Chronic/diagnosis
- Hepatitis, Chronic/drug therapy
- Hepatitis, Chronic/virology
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/drug therapy
- Hepatitis, Viral, Human/transmission
- Hepatitis, Viral, Human/virology
- Humans
- Medical History Taking
- Primary Health Care
- RNA, Viral/immunology
- Risk Factors
- United States
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Affiliation(s)
- Luis S Marsano
- Department of Medicine, Division of Gastroenterology/Hepatology, University of Louisville School of Medicine, Louisville Veterans Affairs Medical Center and Jewish Hospital, Louisville, KY 40402, USA.
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Abstract
OBJECTIVES To assess current knowledge of sexually transmitted viral hepatitis in relation to epidemiology, clinical presentation, management, and diagnosis with particular reference to resource-poor settings. METHOD A search of published literature identified through Medline from 1966 to October 2001, the Cochrane Library, and reference lists taken from each article obtained. Textword and MeSH searches for hepatitis A, B, C, D, E, G, delta, GB virus, GBV-C, and TT virus were linked to searches under the textword terms sex$, prevent$, and MeSH subheadings, microbiology, complications, drug therapy, therapy, diagnosis, epidemiology, transmission, and prevention and control. CONCLUSIONS In heterosexual relationships, hepatitis B is readily transmitted sexually and hepatitis C and D less so, with no evidence for sexual transmission of hepatitis A. Hepatitis types A-D are all transmissible sexually in male homosexual relationships under certain conditions. In resource-poor countries sexual transmission is generally only a significant route of transmission for hepatitis B.
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Affiliation(s)
- M G Brook
- Patrick Clements Clinic, Central Middlesex Hospital, Acton Lane, London NW10 7NS, UK.
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Delpech VC, Thackway SV, Young LC, Pontivivo G, Smedley EJ, Morgan KR, Ferson MJ. Outbreak of hepatitis A among illicit drug users in southeast Sydney. Med J Aust 2000; 172:143. [PMID: 10735031 DOI: 10.5694/j.1326-5377.2000.tb127949.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gilroy NM, Tribe IG, Passaris I, Hall R, Beers MY. Hepatitis A in injecting drug users: a national problem. Med J Aust 2000; 172:142-3. [PMID: 10735030 DOI: 10.5694/j.1326-5377.2000.tb127948.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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