Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co-infection with silent hepatitis B.
OBJECTIVE
To determine the prevalence of hepatitis A, B and C viruses in patients attending a methadone maintenance clinic in New York City.


METHODS
Cross-sectional.


METHODS
The Adult Services Clinic of Weill Cornell Medical College, an urban hospital-affiliated methadone program.


METHODS
Former heroin addicted adults (n = 103) on methadone maintenance therapy.


METHODS
Markers for hepatitis A virus [HAV immunoglobulin M (IgM) and imunoglobulin G (IgG)], hepatitis B [hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb)] and hepatitis C virus (HCVAb). Serum alanine aminotransferase (ALT) and quantitative HCV RNA were also obtained. Qualitative detection of HBV DNA and HCV genotype were obtained in a subset of subjects.


RESULTS
More than 40% of subjects had markers for all three viruses. HCVAb was the most prevalent (83.5%), followed by HBcAb (65.0%), HAV IgG (46.1%) and HBsAb (41.1%). Hepatitis C RNA was detected in 70.6% of HCVAb positive subjects. While no subject had HBsAg, HBV DNA was detected in 26.4% of subjects who underwent this measure; all (n = 20) had HBcAb as their only HBV marker. The presence of HBV DNA did not influence ALT. Subjects with HCV RNA had higher ALTs than those without HCV RNA.


CONCLUSIONS
Most methadone-maintained subjects had at least one marker for viral hepatitis, with 41.8% having markers for HAV, HBV and HCV. A quarter of subjects had silent HBV infection, defined as the presence of HBV DNA in the absence of HBsAg. These subjects should be considered infectious and pose a public health risk.
Bart
Gavin
G
The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, NY, NY 10021, USA. kreek@rockefeller.edu
Piccolo
Paola
P
Zhang
Linqi
L
Jacobson
Ira
I
Schaefer
Robert A
RA
Kreek
Mary Jeanne
MJ
D000328:Adult; D000368:Aged; D002353:Carrier State / Q000175:diagnosis*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D018963:Hepatitis Antigens / Q000097:blood*; D006525:Hepatitis, Viral, Human / Q000175:diagnosis*; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009519:New York City; D012698:Serologic Tests / Q000379:methods
D004279:DNA, Viral; D018963:Hepatitis Antigens; D009294:Narcotics; D008691:Methadone