Prevalence of Hepatitis C Virus Infection in U.S.

Prevalence of Hepatitis C Virus Infection in U.S.
Posted by FoM on December 30, 1999 at 08:24:33 PT
December 30, 1999 -- Vol. 341, No. 27 
Source: New England Journal of Medicine 
Alter et al. (Aug. 19 issue) (1) present valuable data on the prevalence of hepatitis C virus (HCV) infection in the United States. However, their analyses of risk factors for HCV infection are flawed because the third National Health and Nutrition Examination Survey (NHANES III) data did not contain information necessary to control for confounding by the single most important risk factor for HCV infection -- namely, injection-drug use.
Their conclusions regarding the transmission of HCV by illegal drug use and sexual promiscuity should not be used to counsel patients or to set public health policy. Although the omission of a question of injection-drug use from NHANES III is unfortunate in itself, the inability to control for injection-drug use should have led the authors either to omit this analysis or to be much more circumspect in their conclusions. They acknowledge in the discussion that injection-drug use is the single most important risk factor for HCV infection; other authors have estimated that the odds ratio for HCV seropositivity associated with injection-drug use is more than 100. (2) Since injection-drug use is also associated with smoking marijuana, inhaling cocaine, and sexual promiscuity, it is likely that the associations with these variables were confounded by its omission from the logistic-regression model. The authors correctly discount marijuana use as a means of HCV transmission and recognize that the previously reported associations of cocaine inhalation with HCV infection may have been confounded by injection-drug use. (3) In contrast to the findings in the few references cited by Alter et al., a broader review of the literature suggests that sexual transmission of HCV is inefficient at best. (4) In the light of these facts and the probable confounding mentioned above, the conclusion of Alter et al. that "the strongest factors independently associated with HCV infection were illegal drug use and high-risk sexual behavior" is unfortunate. Click the link to read the complete article. Article:The Hepatitis C Handbook - DrugSense Liver Disease Lurks Behind Bars - 10/19/99
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