ABSTRACT
The authors evaluated the association between hepatitis C virus (HCV) seropositivity status and substance use treatment outcomes in an alcohol- and substance-dependent population undergoing rehabilitation. The second aim was to assess the impact of early screening for HCV infection and substance use treatment on HCV treatment outcomes. HCV-antibody testing of 338 patients attending a substance-use residential program was performed. HCV antibody status, lifetime comorbid psychiatric diagnoses, program completion rates, and 6-month abstinence rates after program discharge were assessed. HCV treatment outcomes were followed in patients who remained abstinent 6 months after completion of substance-use treatment. Almost one-fourth (23.1%) of patients were HCV antibody-positive. HCV-seropositive patients were more likely to complete the 28-day program and more likely to remain abstinent at 6 months after program discharge. HCV seropositive status was the strongest predictor for the likelihood of completing the program, and remaining abstinent for 6 months afterward. Patients with HCV who completed a substance-use treatment program were more likely to receive HCV treatment than substance-dependent patients with HCV who never attended a substance-use treatment program. Detecting HCV infection in the structured setting of substance-use treatment is ideal to initiate management of this infection, and it has a positive influence on the outcomes of both substance-use treatment and HCV treatment.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Interferons/therapeutic use , Mass Screening/methods , Substance-Related Disorders/epidemiology , Antibodies, Viral/immunology , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/epidemiology , Comorbidity , Demography , Diagnostic and Statistical Manual of Mental Disorders , Female , Hepatitis C/immunology , Humans , Male , Middle Aged , Population Surveillance , Prevalence , Substance-Related Disorders/diagnosis , Treatment OutcomeABSTRACT
Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti-hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1288 of 3863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of antihepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans.
