Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co‐infection with silent hepatitis B

Abstract

Aims-To determine the prevalence of hepatitis A, B and C viruses in patients attending a methadone maintenance clinic in New York City. Design-Cross-sectional.Setting-The Adult Services Clinic of Weill Cornell Medical College, an urban hospitalaffiliated methadone program.Participants-Former heroin addicted adults (n = 103) on methadone maintenance therapy. 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. Measurements-MarkersConclusions-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.

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

“…Although one study suggested that superinfection with hepatitis A virus may increase the risk of fulminant hepatitis in patients with chronic HCV infection [88], others have not confirmed this [89]. Hepatitis A [89] and B [90] vaccinations of susceptible HCV-infected patients are recommended.…”

Viral Hepatitis Among Drug Users in Methadone Maintenance: Associated Factors, Vaccination Outcomes, and Interventions

“…In our series, the vast majority of those with isolated HBc Ab did not have chronic HBV infection but rather that isolated core status reflected remote HBV infection with loss of HBs Ab over time; this has been the case in most, but not all, series. 4, 13, 35 The vast majority of those with isolated HBc Ab therefore, needed HBV vaccination, as loss of adequate HBs Ab has been associated with susceptibility to re-infection. 1, 41 Those with HCV Ab seropositivity had poorer responses to HBV vaccination as has been seen in some series, but in other series the association lost significance when smoking, which is associated with poorer responses to HBV vaccination, was included in analyses.…”

Bidirectional translational research: Progress in understanding addictive diseases

“…We have made a novel finding, the unexpected presence of hepatitis B DNA, that is, “silent hepatitis B,” in clinically well patients (Bart et al, 2008). In a cross-sectional study of 103 adults in long-term methadone-maintenance treatment in a single clinic, we looked for evidence of past or current infection with hepatitis A, B and C in specially obtained blood specimens.…”

“…These subjects all had hepatitis B core antibody, but as their only hepatitis B virus marker. This finding of silent hepatitis B virus infection with identifiable virus in long-term methadone-maintained patients must be interpreted as a potential health risk, both for the individual in any setting of any future immune suppression, and, less possibly, as a source of contamination for blood supplies (Bart et al, 2008). In another report, we have reviewed current issues for hepatitis C infection treatment in patients in long-term opiate-agonist treatment with methadone maintenance (Novick et al, 2008).…”