Prevalence of hepatitis B and C infection in a methadone clinic population: implications for hepatitis B vaccination

Aims. To examine the HBV and HCV markers of injecting drug users on methado ne maintenance, and the feasibility of vaccination at the drug clinic. Methods. Systematic serological testing of patients for hepatitis B and C w as undertaken, and free hepatitis B vaccination was offered via arrange cli nic appointments. Results. Hepatitis B serology was obtained in 163 of the 20 clinic patients . 85 (52.1%) patients had evidence of hepatitis B exposure, and 3 (1.8%), o f previous vaccination. Positive hepatits B markers were associated with in creasing age (p=0.004), and the duration of injecting prior to treatment (p =0.008). Hepatitis B and C serology was obtained for 153 patients, with 76 (49.7%) having evidence of dual exposure. 164 (84.1%) of 195 patients were positive for antibody to hepatitis C. Completion of the vaccine course was lower than anticipated (36.5% of HBV negative patients). Conclusions. The high rates of hepatitis B exposure in injecting drug users on methadone treatment confirm the need for hepatitis B vaccination, parti cularly in view of their endemic hepatitis C infection. Monitoring of this group for the development of chronic liver disease and hepatocellular carci noma is recommended. Routine cost-free vaccination of patients on entering drug treatment, using a rapid vaccination schedule, may improve compliance.