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Study Urges Doctors to Screen for Hepatitis
Many with Hepatitis Are Undetected: 20% present with cirrhosis
Reported by Jules Levin
Many individuals are not being tested by their primary care physician
for hepatitis. As a result individuals are not getting proper care
until they get sick. A study presented at the AASLD liver meeting in
Boston last week (Oct 25-29) 20% of patients already had cirrhosis at
the time of their diagnosis with hepatitis. A significant number of
patients identified in this study had hepatitis C for 25 years
already. It is important to raise awareness with physicians and the
general public about testing for hepatitis C and B, both of which can
be treated successfully. Beth P Bell from the Centers for Disease
Control and Prevention and Andre N Sofair, from the Connecticut
Emerging Infections Program and Yale University School of Medicine
presented this study at the AASLD liver conference last week in
Hepatitis C is an important cause of chronic liver disease (CLD) in
the United States, but clinical and virological features of
newly-recognized patients have not been well characterized.
Researchers conducted active prospective surveillance for adult cases
of newly-diagnosed chronic liver disease in gastroenterology (GI)
practices in New Haven County CT, Multnomah County OR, and Alameda
County Kaiser Permanente Health Plan, Oakland, CA (total population
under surveillance 1.48 million).
Chronic hepatitis C was defined as abnormal liver tests of at least
six months duration, and/or pathologic, clinical, or radiographic
evidence of chronic liver disease, with serologic and/or virologic
evidence of hepatitis C virus infection.
Consenting patients were interviewed, a blood specimen obtained, and
the medical record reviewed. Heavy drinking was defined as reported
average alcohol consumption of 60 gms/day (men) or 30 gms/day (women)
for >10 years.
A diagnosis of cirrhosis was based on clinical, histological, or
The study researchers identified 615 patients with newly-diagnosed
hepatitis C in GI practices in 2000 (incidence 41.6/100,000
population). Incidence was highest among patients aged 35-54 years
(79.8/100,000) and higher among men (53.7/100,000) than women
Among the 251 (41%) interviewed patients to date, the median age was
46 years (range 19-78); 158 (63%) were male. A total of 187 (77%)
were white and 37 (15%) were African-American; 10% reported Hispanic
ethnicity. The most frequently reported symptom at the time of
diagnosis was fatigue (48%); 43% were asymptomatic.
Among 229 (91%) patients reporting ever drinking > one drink/month,
86 (38%) were heavy drinkers. At least one recognized source of
infection was reported by 214 (85%) patients, most commonly injection
drug use (67%).
Median estimated age at infection was 21 years (range 1-66). At the
time of diagnosis, median estimated years since infection was 24
(range 2 42). Of 178 patients with complete information to date, 36
(20%) had cirrhosis at the time of diagnosis, all but two of whom had
elevated liver enzymes.
Patients with and without cirrhosis were similarly distributed with
respect to age (median 47, 46 years, respectively); one third of
patients with cirrhosis were < 45 years old. There was evidence of
cirrhosis among 24% of men and 13% of women. The prevalence of
cirrhosis was 31% among heavy drinkers and 14% among patients not
considered heavy drinkers. A total of 20 (56%) cirrhotic patients
were heavy drinkers. Among the 46 men infected for > 25 years, 38% of
heavy drinkers had cirrhosis.
In this population-based study of patients newly-diagnosed with
hepatitis C, a considerable proportion had been infected for more
than 25 years and one fifth already had cirrhosis at the time of GI
referral. More than half of patients with cirrhosis were heavy
drinkers. Heavy alcohol use is an important contributor to hepatitis
C-associated morbidity. To promote early identification of patients
with chronic hepatitis C, improved awareness among primary care
physicians and patients of the importance of risk factor-based
serologic testing is needed.
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