Chronic viral hepatitis is a significant contributor to the immunosenescent phenotype of parenteral drug addiction.
Intravenous drug addiction is known to be associated with an inordinate morbidity and mortality. As our previous report had identified an immune phenotype consistent with accelerated ageing, we wished to investigate how much of this change may have been related to chronic viral hepatitis. A total of 12 409 clinical pathology results from the period 1995-2007 were reviewed. To control for the differences in age, only patients less than 48 years of age were considered. A total of 636 substance use disorder (SUD) and 6103 non-SUD (N-SUD) patients were studied. They had comparable ages (mean +/- SD 31.32 +/- 6.90 versus 31.57 +/- 9.23, P-value not significant), but the SUD group had more males (74.37% versus 53.20%, P < 0.001). For most of the changes examined splitting the two SUD groups into hepatitis C positive (HCV+) and hepatitis C negative (HCV-) demonstrated that the majority of the described changes were most marked in the HCV+ group. The globulins were higher in the HCV+ group and the albumin was lower and fell more markedly with age than in N-SUD or HCV- (all P < 0.001). The globulin/albumin ratio was significantly higher in HCV+ than HCV- or N-SUD (both P < 0.0001) and rose more with age. These changes were paralleled by the ESR, elevations in the CRP and lymphocyte count. Transaminases were elevated in SUD and HCV+ groups compared with N-SUD (all P < 0.02). At multivariate analysis ESR, lymphocyte count, dual hepatitis B and C seropositivity, AST and HCVAb were significant predictors of the serum globulin level and accounted for 21% of the variance. These data extend our earlier report and show that much of the immunosenescent phenotype of SUD, encompassing the known immunosuppression and the observed immunostimulation, is statistically related to chronic viral hepatitis. Important theoretical and practical management (vaccination) implications ensue.
Reece
Albert S
AS
University of Queensland Medical School, Southcity Family Medical Centre, Brisbane, Australia. sreece@bigpond.net.au
D000293:Adolescent; D000328:Adult; D002648:Child; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000235:genetics* / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000097:blood / Q000235:genetics* / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy; D008214:Lymphocytes / Q000276:immunology / Q000378:metabolism; D008297:Male; D002189:Marijuana Abuse / Q000097:blood / Q000235:genetics; D008875:Middle Aged; D010290:Parents; D010641:Phenotype; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000235:genetics*; D000637:Transaminases / Q000097:blood; D055815:Young Adult
D006514:Hepatitis B Surface Antigens; D000637:Transaminases