Miolo Gastro 43(1).indd

Background The prevalence of hepatitis C virus (HCV) infection is elevated in alcoholic patients, but the risk factors are unclear. The role of parenteral risk factors are indeterminated in this population. Aims To determine the prevalence of hepatitis C virus infection in alcoholic patients admitted to a detoxifi cation unit and to evaluate the presence of underlying parenteral risk factors. Methods A total of 114 consecutive unselected alcoholic patients admitted to a single chemical dependency unit during 14 month were included. Epidemiological data and history of parenteral risk factors for hepatitis C virus infection were obtained with a standardized questionnaire. Blood was collected for determination of aminotransferases and anti-hepatitis C virus antibodies (ELISA-3). Positive samples were confi rmed by polymerase chain reaction and tested for genotype. Results Among the 114 alcoholics, 17 (15%) were anti-hepatitis C virus positive. Of these, 12 (71%) had detectable serum HCV-RNA by PCR. Genotype 1 was found in six cases and genotype 3 in fi ve (one patient was undetermined). Forty-nine (43%) patients had elevated serum ALT and/or AST at baseline. The comparison between the 17 positive and the 97 negative patients showed signifi cant differences in mean serum ALT levels (42 ± 41 IU/L vs. 22 ± 20 IU/L), rate of elevated ALT (65% vs. 34%), and presence of parenteral risk factors (94% vs. 10%). Comparison between alcoholic patients with and without elevated aminotransferases showed signifi cant difference only in the rate of positive anti-hepatitis C virus antibodies (24% vs. 7%). Furthermore, among the 17 anti-hepatitis C virus positive patients, the rate of detectable HCV-RNA was signifi cantly higher in the 12 with elevated aminotransferases versus the 5 with normal aminotransferases (92% vs. 20%). Conclusions There was a high prevalence of anti-hepatitis C virus antibodies in alcoholics and the majority was confi rmed by the presence of detectable HCV-RNA. Intravenous drug use was the main risk factor for hepatitis C virus infection in this population. HEADINGS – Hepatitis C. Alcoholism. Substance abuse, intravenous. The present study was performed at the Chemical Dependency Unit, “Hospital Mãe de Deus”, Porto Alegre, RS, Brazil. 1 “Hospital Mãe de Deus”; 2 Federal Faculty of Medical Sciences Foundation; 3 Symbios Biotechnology and Lutheran University of Brazil, Porto Alegre, RS, Brazil. Address for correspondence: Dr. Bruno Galperim Rua Costa, 30/404 90110 270 Porto Alegre, RS, Brazil. E mail: [email protected] INTRODUCTION Hepatitis C virus (HCV) infects approximately 200 million people worldwide and is presently considered one of the main causes of chronic liver disease in most parts of the world. HCV is known to be transmitted primarily by the parenteral route, mainly through exposure to contaminated blood and/or blood products. The main risk factor for HCV infection is currently intravenous drug use (IVDU), which accounts for 60% of cases. Several studies have demonstrated a high prevalence of anti-HCV among alcohol-dependent individuals but the mode of transmission is not clearly understood 7, 10, 13, 20, 21, 22, 23, 24, 26, 27, 30, . The purpose of this study was to determine the prevalence of HCV infection in alcoholic patients admitted to a detoxifi cation unit, and to evaluate the role of underlying parenteral risk factors. ARQGA/1215 Miolo Gastro 43(1).indd 81 24/8/2006 11:37:41 Process Black 82 Arq Gastroenterol v. 43 – no.2 – abr./jun. 2006 PATIENTS AND METHODS Patient selection and study design All patients were recruited from a single chemical dependency unit located at “Hospital Mãe de Deus”, a tertiary general hospital in the city of Porto Alegre, RS, southern Brazil. A total of 114 alcoholic patients were consecutively admitted to this unit for treatment of alcoholic dependency during 14 month. All patients were prospectively interviewed by the same investigator, who was blinded to the HCV test results and used a standardized questionnaire designed to obtain epidemiological data, such as mean alcohol intake, history of intravenous drug use anytime, blood transfusion prior to 1992, and/or transfusion of blood products before 1987. Informed consent was obtained from each patient, and approval for the study protocol was granted by the Ethics Committee of the institution. Inclusion criteria were defi ned as a diagnosis of alcohol dependency according to ICD-10, signed informed consent and availability of a blood sample for biochemical and serological tests. The only exclusion criterion was inability to answer the questionnaire. No patient was excluded from the study. Biochemical and serological investigations Blood was collected within the fi rst 24 hours of admission for determination of serum levels of alanine aminotransferase (ALT; standard method), aspartate aminotransferase (AST; standard method) and antibodies to anti-HCV (COBAS CORE Anti-HCV EIA II; Roche Diagnostics). Patients with detectable anti-HCV antibodies underwent a second blood collection during admission to assess the presence of HCV RNA by polymerase chain reaction (PCR; COBAS AMPLICOR; Roche Diagnostics). Determination of HCV genotype was performed on PCR-positive samples using restriction fragment length polymorphism as previously described. Data processing and statistical methods Descriptive methods were used in the univariate analysis. A bivariate analysis was also performed and yielded odds ratio (OR) and a 95% confi dence interval (CI). Stratifi ed analyzes were used to assess the independent contribution of each exposure factor studied. In this analysis, the chi-square and the MantelHaenszel tests were used. The chi-square test was used for categorical variables (Fisher’s exact test was used for values below 5). In regard to continuous variables, the analysis of variance (ANOVA) was used for data presenting normal distribution, and the Kruskal-Wallis test was used for nonparametric data . Statistical signifi cance was set at P<0.05.