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PAPERS: Ingrid van Beek, Robyn Dwyer, Gregory J Dore, Kehui Luo, and John M Kaldor Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study BMJ 1998; 317: 433-437 [Abstract] [Full text]

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Hepatitis A, B, and C and HIV infection in Munich

Backmund   (21 September 1998)

Hepatitis A, B, and C and HIV infection in Munich 21 September 1998
Backmund Krankenhaus München Schwabing Send response to journal: Re: Hepatitis A, B, and C and HIV infection in Munich	Backmund M, Stephan E, v Zielonka M, Eichenlaub D Infection with Hepatitis A, B and C as well as HIV We would like to confirm and expand on the data collected by van Beek et al. (1) with our data for a large city in Germany (Munich) on the prevalence of HIV and Hepatitis c infections in intravenous drug users. From 1991-1996, we cared for 1051 drug-dependent patients in a maximal care hospital facility. Each patient was examined during his/her stay for most important infections. Once a week, all patients were instructed about how infections are spread, as well as about possibilities for inhibiting and preventing infections. At admittance, the prevalence of hepatitis A was 21.8%, hepatitis B was 39.9% and hepatitis C was 61.9%. 4.1% of the patients had infected themselves with HIV (2). Three hundred and seventy-two of the 1051 patients were treated in hospital multiple times. We observed these patients for signs of seroconversions. This data can be differentiated a little from that collected in Australia in the following way: During the period observed (6 years), we had no new HIV infections; in contrast Sydney had 2 infections/426 patients (Tab. 1).The seroconversions with regard to hepatitis C were also clearly lower in our study with 23 from 372 patients versus 31 of 152 patients in the van Beek et al. Study (1). In addition to this, we mention here the observed infections with hepatitis A and B: 35 of 372 patients infected themselves with hepatitis B and only 8 with hepatitis A. Among these were several multiple infections with hepatitis B and C (n=7), but only one hepatitis A/C infection. Among the patients under 20 years (n=24=, there was a much higher rate of infection than among the older patients; this infection rate was, nevertheless, lower than in the Australian study. There was a hepatitis C seroconversion in 6 patients, hepatitis B seroconversion in 8 patients and there was a high rate of hepatitis B/C multiple infections (n=4). In summary, we can confirm the data collected by van Beek et al. (1), although a much lower rate of seroconversions was observed in the Munich area. This can perhaps be attributed to the weekly explanatory measures on prevention. Based on these data, it becomes clear that it is necessary to vaccinate promptly against hepatitis A and B in seronegative drug- dependent patients ((3) and that there is a high need for information among drug-dependent patients with regard to hepatitis C infections. References 1 van Beek I, Dwyer R, Dore GJ, Luo K, Kaldor JM. Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study. BMJ 1998; 317(7156):433-437 2 Backmund M, Eichenlaub D, Soyka M. Das Bundesmodellprojekt "Qualifizierte Entzugsbehandlung Drogenabhängiger" an einem Krankenhaus der Maximalversorgung: Konzept, Inanspruchnahme und klinische Ergebnisse. Gesundheitswesen 1998; 60: 552-558 3 Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G, Ferraro T, Concia E. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med 1998;338:286-90 Table 1 van Bee Backmund Patients initially seronegative for hepatitis C152 372 Seroconversions hepatitis C 31 23 Patients initially seronegative for HIV. 426 372 Seroconversions HIV 02 0