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Study Urges Doctors to Screen for Hepatitis

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    NATAP - www.natap.org Study Urges Doctors to Screen for Hepatitis Many with Hepatitis Are Undetected: 20% present with cirrhosis Reported by Jules Levin Many
    Message 1 of 1 , Nov 15, 2003
      NATAP - www.natap.org

      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
      radiological findings.

      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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