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Prevalence and characteristics of hepatitis C infection in an inner city substance abuse population
April1998
AASLD A1295
Patient
Histology
Table I1 bDNA (Eq/L)
1-SR 2-SR 3-SR 4-SR 5-SR 6-SR 7-SR 8-NR 9-NR 10-NR 11-NR 12-NR 13-NR 14-NR
CAH CAH CPH CAH CAH CPH CPH cirrhosis CAH CAll CAH CAH cirrhosis CAH
negative negative negative 3.100.000 3.200.000 640.000 negative negative 1.300.000 1.081.000 8.495.000 2.700.000 negative 14.000.000
N ° of aa mutations 8 8 6 5 4 3 2 4 2 2 1 1 1 1
[1] Enomoto et al. N Engl.J.Med. 1996;334-77 • L0396 UTILITY OF HEALTH STATUS QUESTIONNAIRE (SF-36) IN THE ASSESSMENT OF HEALTH STATUS IN PATIENTS WITH CHOLESTATIC LIVER DISEASE. M Malinchoc, WR Kim, KD Lindor, RA Jorgensen, JL Petz, Dickson. Mayo Clinic, Rochester, MN. The Health Status Questionnaire (SF-36), a widely used generic instrument for measuring individual's health status, encompasses eight domains of health including physical functioning (PF), role limitations due to physical problems (RP), bodily pain (BP), general health (GH), vitality (V), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Aim: To describe the health status of patients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) using the SF-36, in comparison to the general population. Methods: The SF-36 was administered in 82 ambulatory patients with well-characterized PBC (n=65) or PSC (n=17) by clinical, biochemical, radiographic, and histologic criteria. Summary scores for the eight domains were computed according to the published scoring scheme. These scores were compared to the gender-specific normative data derived from a random sample of 2474 US adults, using one sample, two tailed t-tests. Results: Of the 82 patients 14 were men and 68 women. The table shows that many of the patients had mild, relatively early stage disease. (median [range] shown). 74 patients were being treated with ursodiol.
i Age i Bi'i inleve' I Albumin I Prothrombintimo 54 (26-75)
0.6 (0.1-5.3) mg/dl
4.0 (2.8-5.2) g/all
9.1 (8.1-11.9) sec.
In men, the mean scores did not differ between patients and general population in any domain, presumably because of the small number. The figure illustrates the difference between female PBC or PSC patients and normal adult women in US. Our patients had higher scores on the social functioning (P=0.01) and mental health (P=0.02) domains. However, they scored significantly lower on the general health domains (P<0.01). Conclusions: Overall, the health status as measured by the SF-36 in patients with ambulatory cholestatic liver disease appears to be similar to that of normal population, although some patients are concerned that their health is likely to get worse, as reflected in the low score in the general health domain. Disease-targeted instruments may be able to detect subtle changes in diseasespecific aspects of health status in these patients.
12.5 * p
i
*~
~-12.5PF RP BP GH V SF REMH
• L0397 PREVALENCE AND CHARACTERISTICS OF HEPATITIS C INFECTION IN AN INNER CITY SUBSTANCE ABUSE POPULATION. Dayaker R. Mallipeddi. Wayne P. Berry, Maurice A. Cerulli, Li-ching Liang. Brooklyn Hospital Center, Brooklyn NY. BACKGROUND: Hepatitis C (HCV) infection is a rapidly growing public health issue in the United States. The substance abuse population in the inner city poses a substantial health problem given their nature of high risk behavior and poor medical follow up. We studied the prevalence of HCV antibody and associated behaviors in our drug and alcohol detoxification unit. METHODS: Consecutive patients admitted to our substance abuse unit in a one month period were interviewed in detail for their medical history and socioeconomic status. In addition to a focused drug history, we collected data on patients' sexual behavior, tattoos/body piercing, blood transfusion history, incarceration history, education level, HIV status, and sexually transmitted diseases (STDs). Standard liver tests, HBV, and HCV serologies (EIA 3rd generation) were sent on every patient. We obtained data on 51 patients agreeing to phlebotomy; 4 patients were excluded from the study because they refused phlebotomy. RESULTS: A total of 39 males and 12 females were studied (23 Hispanic, 23 Black, 4 Caucasian, and 1 Asian). 78% of patients used alcohol, 55% used heroin, and 59% used crack/cocaine on a daily basis. 75% were polysubstance users. The mean number of years of substance abuse for all patients was 16 + 8yr. 27% reported IV drug use, 20% had a history of STDs, 22% had tattoos, 16% were known HIV positive, 6% had a history of blood transfusions, and 92% had a history of multiple sexual partners. 33% of our patients were previously incarcerated, 59% did not complete high school, 80% were unemployed, and 98% were heterosexual. The prevalence of HCV exposure in this group was 43% (22/51). The mean age of the patients was 41 -+ 8yr for the infected (HCV+) group vs. 36 -- 8yr for the uninfected (HCV-) group (p=.04). The mean AST and ALT levels were 55 +- 28 and 55_+ 33 for the HCV+ group and 35 + 25 and 35-+ 28 for the HCV- group (p=.01 and p=.03). 55% of HCV+ patients used intravenous drugs vs. 7% of the HCV- group (p<.001). A history of HIV infection and blood transfusions was also associated with the HCV+ group compared to the HCV- group (p<.05). The association of STDs, tattoos, multiple sex partners, incarceration, education/employment status, and psychiatric history in the HCV+ group was not statistically different compared to the HCV- group. CONCLUSIONS: In our drug and alcohol population, the prevalence of HCV antibody was high (43%). HCV infected patients had significantly higher AST/ALT values and were older than uninfected patients. Considering all risk factors for HCV transmission, a history of IV drug use was the most statistically important association seen with our HCV infected patients. The inner city substance abuse population is a significant reservoir for HCV infection; routine HCV antibody testing should be performed in this group. • L0398
SKIN IS NOT A SITE OF HCV REPLICATION IN LICHEN PLANUS (LP). A.Mangia, P.Zenarola ^, I.Cascavilla, MR.Villani, V.Annese, R.Gentile, M. Lomuto^, A.Andriulli. Gastroenteml. and ^Dermatol. IRCCS S.Giovanni lL Italy. Association between LP and HCV chronic infection is not casual. It has been postulated that cell-mediated toxicity against a viral epitope in the epidermidis could trigger LP lesions in pts with HCV infection. With the purpose to investigate presence of HCV in the skin, we have evaluated, by RNA extraction and RT-nested PCR for HCV, serum, liver and skin in HCV Ab+ve pts with histologically proven LP. HCV genotype was evaluated by Innolipa. 12 pts were studied: 9 were female, mean age 52.2 (range 38-66 yrs). Liver cirrhosis (LC) was demonstrated in 7 pts, and chronic active hepatitis (ECA) in the remaining. The majority (55%) of pts had cutaneous lesions. Results are shown in the table: N.
HCV
R N A +ve
HCV
LC (7)
serum 6/7
skin 0/7
liver 6/7
type 2a/c 4/6
CAH (5)
5/5
0/5
5/5
3/5
In contrast to the 37.8% prevalence rate of HCV genotype 2a in the general population in our geographic area, pts with LP appear to be prevalently infected by genotype 2a (63.6%). In these pts HCV replicates within the liver but not in the skin, suggesting that cutaneous lesions might originate from mechanisms other than the suggested cell-mediated toxicity to viral epitopes present in the skin.
AASLD A1295
Patient
Histology
Table I1 bDNA (Eq/L)
1-SR 2-SR 3-SR 4-SR 5-SR 6-SR 7-SR 8-NR 9-NR 10-NR 11-NR 12-NR 13-NR 14-NR
CAH CAH CPH CAH CAH CPH CPH cirrhosis CAH CAll CAH CAH cirrhosis CAH
negative negative negative 3.100.000 3.200.000 640.000 negative negative 1.300.000 1.081.000 8.495.000 2.700.000 negative 14.000.000
N ° of aa mutations 8 8 6 5 4 3 2 4 2 2 1 1 1 1
[1] Enomoto et al. N Engl.J.Med. 1996;334-77 • L0396 UTILITY OF HEALTH STATUS QUESTIONNAIRE (SF-36) IN THE ASSESSMENT OF HEALTH STATUS IN PATIENTS WITH CHOLESTATIC LIVER DISEASE. M Malinchoc, WR Kim, KD Lindor, RA Jorgensen, JL Petz, Dickson. Mayo Clinic, Rochester, MN. The Health Status Questionnaire (SF-36), a widely used generic instrument for measuring individual's health status, encompasses eight domains of health including physical functioning (PF), role limitations due to physical problems (RP), bodily pain (BP), general health (GH), vitality (V), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Aim: To describe the health status of patients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) using the SF-36, in comparison to the general population. Methods: The SF-36 was administered in 82 ambulatory patients with well-characterized PBC (n=65) or PSC (n=17) by clinical, biochemical, radiographic, and histologic criteria. Summary scores for the eight domains were computed according to the published scoring scheme. These scores were compared to the gender-specific normative data derived from a random sample of 2474 US adults, using one sample, two tailed t-tests. Results: Of the 82 patients 14 were men and 68 women. The table shows that many of the patients had mild, relatively early stage disease. (median [range] shown). 74 patients were being treated with ursodiol.
i Age i Bi'i inleve' I Albumin I Prothrombintimo 54 (26-75)
0.6 (0.1-5.3) mg/dl
4.0 (2.8-5.2) g/all
9.1 (8.1-11.9) sec.
In men, the mean scores did not differ between patients and general population in any domain, presumably because of the small number. The figure illustrates the difference between female PBC or PSC patients and normal adult women in US. Our patients had higher scores on the social functioning (P=0.01) and mental health (P=0.02) domains. However, they scored significantly lower on the general health domains (P<0.01). Conclusions: Overall, the health status as measured by the SF-36 in patients with ambulatory cholestatic liver disease appears to be similar to that of normal population, although some patients are concerned that their health is likely to get worse, as reflected in the low score in the general health domain. Disease-targeted instruments may be able to detect subtle changes in diseasespecific aspects of health status in these patients.
12.5 * p
i
*~
~-12.5PF RP BP GH V SF REMH
• L0397 PREVALENCE AND CHARACTERISTICS OF HEPATITIS C INFECTION IN AN INNER CITY SUBSTANCE ABUSE POPULATION. Dayaker R. Mallipeddi. Wayne P. Berry, Maurice A. Cerulli, Li-ching Liang. Brooklyn Hospital Center, Brooklyn NY. BACKGROUND: Hepatitis C (HCV) infection is a rapidly growing public health issue in the United States. The substance abuse population in the inner city poses a substantial health problem given their nature of high risk behavior and poor medical follow up. We studied the prevalence of HCV antibody and associated behaviors in our drug and alcohol detoxification unit. METHODS: Consecutive patients admitted to our substance abuse unit in a one month period were interviewed in detail for their medical history and socioeconomic status. In addition to a focused drug history, we collected data on patients' sexual behavior, tattoos/body piercing, blood transfusion history, incarceration history, education level, HIV status, and sexually transmitted diseases (STDs). Standard liver tests, HBV, and HCV serologies (EIA 3rd generation) were sent on every patient. We obtained data on 51 patients agreeing to phlebotomy; 4 patients were excluded from the study because they refused phlebotomy. RESULTS: A total of 39 males and 12 females were studied (23 Hispanic, 23 Black, 4 Caucasian, and 1 Asian). 78% of patients used alcohol, 55% used heroin, and 59% used crack/cocaine on a daily basis. 75% were polysubstance users. The mean number of years of substance abuse for all patients was 16 + 8yr. 27% reported IV drug use, 20% had a history of STDs, 22% had tattoos, 16% were known HIV positive, 6% had a history of blood transfusions, and 92% had a history of multiple sexual partners. 33% of our patients were previously incarcerated, 59% did not complete high school, 80% were unemployed, and 98% were heterosexual. The prevalence of HCV exposure in this group was 43% (22/51). The mean age of the patients was 41 -+ 8yr for the infected (HCV+) group vs. 36 -- 8yr for the uninfected (HCV-) group (p=.04). The mean AST and ALT levels were 55 +- 28 and 55_+ 33 for the HCV+ group and 35 + 25 and 35-+ 28 for the HCV- group (p=.01 and p=.03). 55% of HCV+ patients used intravenous drugs vs. 7% of the HCV- group (p<.001). A history of HIV infection and blood transfusions was also associated with the HCV+ group compared to the HCV- group (p<.05). The association of STDs, tattoos, multiple sex partners, incarceration, education/employment status, and psychiatric history in the HCV+ group was not statistically different compared to the HCV- group. CONCLUSIONS: In our drug and alcohol population, the prevalence of HCV antibody was high (43%). HCV infected patients had significantly higher AST/ALT values and were older than uninfected patients. Considering all risk factors for HCV transmission, a history of IV drug use was the most statistically important association seen with our HCV infected patients. The inner city substance abuse population is a significant reservoir for HCV infection; routine HCV antibody testing should be performed in this group. • L0398
SKIN IS NOT A SITE OF HCV REPLICATION IN LICHEN PLANUS (LP). A.Mangia, P.Zenarola ^, I.Cascavilla, MR.Villani, V.Annese, R.Gentile, M. Lomuto^, A.Andriulli. Gastroenteml. and ^Dermatol. IRCCS S.Giovanni lL Italy. Association between LP and HCV chronic infection is not casual. It has been postulated that cell-mediated toxicity against a viral epitope in the epidermidis could trigger LP lesions in pts with HCV infection. With the purpose to investigate presence of HCV in the skin, we have evaluated, by RNA extraction and RT-nested PCR for HCV, serum, liver and skin in HCV Ab+ve pts with histologically proven LP. HCV genotype was evaluated by Innolipa. 12 pts were studied: 9 were female, mean age 52.2 (range 38-66 yrs). Liver cirrhosis (LC) was demonstrated in 7 pts, and chronic active hepatitis (ECA) in the remaining. The majority (55%) of pts had cutaneous lesions. Results are shown in the table: N.
HCV
R N A +ve
HCV
LC (7)
serum 6/7
skin 0/7
liver 6/7
type 2a/c 4/6
CAH (5)
5/5
0/5
5/5
3/5
In contrast to the 37.8% prevalence rate of HCV genotype 2a in the general population in our geographic area, pts with LP appear to be prevalently infected by genotype 2a (63.6%). In these pts HCV replicates within the liver but not in the skin, suggesting that cutaneous lesions might originate from mechanisms other than the suggested cell-mediated toxicity to viral epitopes present in the skin.