Prevalence and distribution of hepatitis C subtypes in patients with opioid dependence

Aim and Setting: The drug addiction out-patient clinic at the University Ho spital for Psychiatry in Vienna performed a study to identify the prevalenc e of hepatitis C virus (HCV) infections in a group of opiate-dependent pati ents, to detect the distribution of HCV subtypes and to calculate the comor bidity of human immunodeficiency virus (HIV) and hepatitis B virus (HBV). D esign and Participants: We consecutively investigated unselected patients ( n = 173) during an observation period of 2 months with the diagnosis of opi oid dependence (DSM-IV: 304.0) and polysubstance dependence (DSM-IV: 304.9) . Measurements: Blood was investigated focusing on liver enzymes and on vir al status including HIV, hepatitis B and hepatitis C, followed by subtyping of the virus. Findings: In 80.3% hepatitis C antibodies were found, 66.5% were HCV RNA (PCR) positive. 3a was the most frequent subtype (35.6%), foll owed by 1a (28.8%) and 1b (22.0%). Four patients had both subtypes 1a and 1 b (6.8%), 3 were 2b positive (5.1%) and 1 patient had subtypes 2a/2c (1.7%) . No significant difference in aspartate (AST) and alanine aminotransferase s (ALT) concerning the different subtypes (AST: p = 0.290; ALT: p = 0.260) could be calculated; 11.6% showed alpha -infection with HIV, 2 patients had a chronic infection with hepatitis B. Conclusions: The rate of HCV infecti on in substance-dependent patients at our drug addiction out-patient clinic is extremely high. The distribution of subtypes showed a relatively homoge neous distribution of the types 1a, 1b and 3a. The recommended therapy with alpha -interferon should be initiated in drug-dependent patients under con siderations of an enrollment in oral maintenance with synthetic opioids. Co pyright (C) 2000 S. Karger AG, Basel.