Many patients with chronic hepatitis C virus (HCV) infection report disabling fatigue and a reduced sense of well-being. Scores on quality of life (QOL) scales, such as the Sickness Impact Profile or the Short Form 36 (SF-36) scale, have been reported as significantly worse for patients with HCV than for healthy controls. 1-3 These studies could not, however, determine the impact of HCV diagnosis per se on QOL because all patients were aware of their diagnosis at the time of completion of the QOL scales. A recent editorial in HEPATOLOGY highlighted the question of whether subjective health perceptions are influenced by diagnosis with HCV. 4 This study reports the impact of diagnosis of HCV on QOL. We report here QOL scores of a group of patients with long-standing HCV infection, only approximately half of whom were aware that they were HCV seropositive at the time the QOL scores were measured. To investigate the impact of HCV diagnosis on QOL, we compared the scores between those aware of their serostatus and those not aware. PATIENTS AND METHODSThis study is part of a retrospective cohort study investigating the natural history of chronic HCV infection by following up all persons admitted to Fairfield Infectious Diseases Hospital in Melbourne, Australia, who had a clinical and biochemical diagnosis of acute viral hepatitis between 1971 and 1975 and on whom stored frozen sera from that time were available.Stored serum of 238 patients was strongly reactive for antibody to HCV (anti-HCV). Follow-up methods were systematically applied to locate cohort members; these included searches of death registers, electoral rolls, telephone directories, and contact with next-of-kin. By late 1998, 97 (41%) had been located and recruited into the study. Subjects were told at the time of recruitment that the study was looking at the outcome of hepatitis infection in patients who had been admitted to hospital with hepatitis 25 years ago. Health outcomes in subjects were then assessed by a studyspecific questionnaire, clinical examination, repeat serology, virology, and liver function tests using standardized proformas to record results. As well, all subjects completed the SF-36 scale, a generic and widely used QOL instrument, which has been adapted for use in Australia.5 Once all study results were obtained, the process of imparting the diagnosis of chronic HCV infection (to those unaware of serostatus) and the fact that blood had been taken at the time of original admission (in the early 1970s) and tested as part of this study for anti-HCV was commenced. In this way, patients who were unaware of their anti-HCV status at the time of recruitment completed all parts of the study, including the SF-36 questionnaire, without this knowledge. This approach was taken partly to assess the impact of knowledge of HCV diagnosis on QOL and also to obtain current anti-HCV status, HCV polymerase chain reaction (PCR) results, and liver function test results to allow appropriate counseling as to current health status, degree of infectivity, and l...

Initiation into injecting is a crucial event for continued reproduction of an injecting drug using (IDU) population and for exposure to blood-borne viruses, but little is known about how this happens. Three hundred young injectors were interviewed in Melbourne by peer workers within the first few years of beginning to inject, about the circumstances surrounding their initiation. Most had indications of social disruption, including having left school early, unemployment, family disruption, homelessness and incarceration. First drug injected was most often amphetamines (average age 16 years), most having already used amphetamines by a different route of administration, but with a steady movement thereafter to heroin as the drug of choice. The most common scenario was one in which injecting was unplanned but the person was active in bringing about the initiation. Most identified a significant other who initiated them (few of whom were dealers), and over half had subsequently initiated others into injecting, on average 0.6 per year; after 5 years 237 young injectors had initiated at least 420 others. Those who initiated multiple others were more likely to be unemployed, to inject multiple drugs and to have dealt. Modelling injecting as a communicable phenomenon, where appropriate, may help estimate population dynamics among IDUs. Peer education programmes are likely to be the most effective harm reduction approach among new injectors.

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Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.

The aim of this study was to examine the long-term effects of hepatitis C virus (HCV) infection on a cohort of patients admitted with acute viral hepatitis from 1971 through 1975. The availability of stored sera from this time enabled testing to identify those who were anti-HCV-positive on admission. Sixteen percent (n ‫؍‬ 238) of the cohort tested anti-HCV-positive. The unexposed group was selected from those who were anti-HCVnegative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study-specific questionnaire and clinical, serological, virological, and biochemical assessment. Complete follow-up was achieved on 98 anti-HCV-positive individuals and 201 negatives. Injecting drug use (IDU) was the presumed route of infection. At a mean of 25 years' followup, 54% of the anti-HCV-positive group had evidence of chronic HCV infection (both anti-HCV-and HCV-RNA-positive); the remainder were HCV-RNA-negative. Sixty-nine percent of those chronically infected had elevated serum alanine transaminase (ALT) levels, but only 8% had progressed to overt cirrhosis, and no cases of hepatocellular carcinoma (HCC) were identified. In summary, anti-HCV-positive subjects were 8 times more likely to have died from suicide or drug overdose than from HCVrelated disease. Anti-HCV-positive study subjects were at increased risk of liver-related pathology after 25 years' follow-up, but few had progressed to overt cirrhotic liver disease. Excess mortality in this group was not the result of liver disease. This suggests that the natural history of community-acquired HCV may be more benign than previously thought. (HEPATOLOGY 2000;32:582-587.)