Posted: 31-Oct-2006 << BACK
A Multicenter Study of 3,871 Patients
Background: Although injection drug use and blood transfusions prior to 1992 are well-accepted risk factors for hepatitis C virus (HCV) infection, the evidence for intranasal drug use as a risk factor for HCV is conflicting. Furthermore, many prior studies that have evaluated intranasal drug use as a risk factor for HCV infection were potentially confounded by injection drug use. The aim of this study was to determine the association between intranasal drug use and HCV infection in a large population of patients without traditional risk factors for HCV infection.
Methods: Patients with chronic HCV infection (HCV RNA positive) and controls (HCV antibody negative) completed a detailed questionnaire at the time of their scheduled visit to the outpatient primary care or GI clinic at 3 study sites. Data collected included patient demographics and information on HCV risk factors.
Results: A total of 3,871 patients were enrolled, including 1,930 with chronic HCV infection and 1,941 HCV negative controls. There were no differences in the mean age (55.2 9.0 vs. 55.6 11.3 years, p = 0.34 ) or proportion who were male (80.3% vs. 81.4%, p = 0.39) between HCV-infected patients and controls. However, HCV positive patients were more likely to be racial/ethnic minorities (56.5% vs. 78.5%, p < 0.001). As expected, injection drug use ( 65.9% vs. 17.8%, p < 0.001), blood transfusions prior to 1992 (22.3% vs. 11.1%, p < 0.001), and intranasal use of cocaine or heroin (61.8% vs. 22.6%, p < 0.001) were more common in HCV-infected patients than in control subjects. Patients with HCV infection were significantly more likely to have a history of intranasal drug use (OR = 5.5; 95% CI, 4.8 6.4) and this remained significant after adjustment for age, sex, and race/ethnicity (OR = 5.8; 95% CI, 5.0 6.8). After excluding all patients with a history of ever injecting drugs and those who have had a blood transfusion prior to 1992, a total of 1,886 subjects were remaining for analysis (465 HCV positive and 1,421 controls). Among these 1,886 patients without traditional risk factors for HCV infection, we found that HCV positive patients were still significantly more likely to have a history of intranasal drug use (OR = 1.9; 95% CI, 1.5 2.4) and this remained statistically significant after adjustment for age, sex, and race/ethnicity (OR = 2.0; 95% CI, 1.6 2.5).
Conclusions: Intranasal use of cocaine or heroin is associated with HCV infection, even among those without traditional HCV risk factors such as injection drug use and blood transfusions. All patients who have used intranasal drugs should be offered HCV testing, even if they have never injected drugs.
E. J. Bini1; S. Dhalla1; A. Aytaman 2; C. T. Tenner1; N. B. Shukla1; G. A. Villanueva3; G. Punla1; C. Patterson3; J. Comas2
1. VA Medical Center, New York, NY, USA.
2. VA Medical Center, Brooklyn, NY, USA.
3. Bellevue Hospital, New York, NY, USA.
