Prevalence of Hepatitis C in a Chemically Dependent Population

Background: Drug abuse is the major risk factor for hepatitis C in the United States. The objective of this study was to determine the prevalence of hepatitis C virus (HCV), to identify risk factors for HCV, and to correlate HCV and liver function in patients presenting for inpatient detoxification of substances of abuse. Methods: A total of 687 patients were tested for the presence of antibody to HCV (anti-HCV). Histories related to drug use, sexually transmitted diseases, blood transfusion, and human immunodeficiency virus were obtained, as were serum tests for human immunodeficiency virus, syphilis, hepatitis B, aminotransferases, total bilirubin, and alkaline phosphatase. Results: The overall prevalence of anti-HCV was 63%: 68% in men vs 54% in women (P<.001), with no difference by race. Remarkably, 86% of injecting drug users tested positive for anti-HCV. Identified risk factors for anti-HCV were injecting drug use (P<.001), human immunodeficiency virus infection (P=.003), exposure to hepatitis B virus (P<.001), and a positive rapid plasma reagin test (P=.04). Previous transfusion and history of previous infection with gonorrhea or syphilis did not correlate with the presence of anti-HCV. Patients positive for anti-HCV had significant elevations in aspartate aminotransferase and alanine aminotransferase levels when compared with patients negative for anti-HCV: 50.8 vs 36.7 U/L (P=.002) and 56.0 vs 36.9 U/L (P<.001), respectively. Conclusion: Injecting drug users have an extremely high prevalence of anti-HCV. This is the first demonstration, to our knowledge, that the presence of anti-HCV in drug users is associated with significantly increased levels of serum aminotransferases.