Today's News

Friday, February 23, 1996

Hepatitis C correlates with tattoos, IV drug abuse, says study

Orthopaedic surgeons may want to give extra attention to their patients' histories based on the results of a study of the incidence of hepatitis C infection in orthopaedic patients.

The study, "Incidence of Hepatitis C in a Patient Population Requiring Orthopaedic Surgery," was presented Thursday afternoon by Peter T. Simonian, MD, of the department of orthopaedic surgery at the University of Washington at Seattle.

Studying 425 consecutive patients in one orthopaedic surgeon's practice for one year, Dr. Simonian and his colleagues found that a positive test for hepatitis C virus (HCV) was most highly correlated with the presence of tattoos and a history of intravenous drug abuse.

However, the correlation with IV drug abuse appeared only after a second interview because most patients failed to report their abuse during the initial interview. "It may be worth asking more than once if your patient uses IV drugs," Dr. Simonian said.

The patients underwent the second-generation screening assay, EIA 2.0, which uses a combination of recombinant HCV core antigen and two non-structural antigens. In an initial questionnaire, those with a positive test provided data on age, gender, employment history, transfusion history, immigration status and IV drug abuse history. In a follow-up questionnaire, the patients reported on their history of sexual contact, history of emergency surgery, symptoms of liver disease and the presence of tattoos.

Patients with positive tests also were tested for liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT), antibodies to the hepatitis B virus core antigen, hepatitis B virus surface antigen and antibody to hepatitis A virus. Polymerase chain reaction (PCR) assays for HCV RNA were done in 14 of the HCV-positive patients.

A total of 19 patients had positive tests for HCV infection using the second-generation screening assay. On the initial questionnaire, two patients reported having used IV drugs, but seven did so on the follow-up. Fifteen of the patients had tattoos.

However, only nine of the 17 patients had hepatitis C based on the U.S. Public Health Service algorithm (a positive second-generation screening assay combined with an elevated ALT). Of these, six give a positive report of drug abuse and seven had tattoos.

Dr. Simonian cautioned that orthopaedic surgeons need to be aware of the prevalence of hepatitis C in their elective patients.

"I don't think this study is going to change the way anyone practices orthopaedic surgery," he said. "I think what it does bring out is that there is another virus without a vaccine or treatment that is about three to four times more prevalent than human immunodeficiency virus infection."

Co-authors of the study are Thomas E. Trumble, MD, associate professor, and Mary Gilbert, RN, both of the department of orthopaedic surgery at the University of Washington, Seattle.

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