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Study Urges Doctors to Screen for Hepatitis
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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 Boston.
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 month’s 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 (30.0/100,000).
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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