Hepatitis C Virus Infection in Cocaine Users: A Silent Epidemic

Researchers at the Medical College of Wisconsin have found that up to one-third of cocaine users who thought they were healthy may be infected with hepatitis C. Hepatitis C can lead to chronic hepatitis, cirrhosis of the liver and even liver cancer. There is no cure or vaccine.

It has been suggested by some researchers that Hepatitis C infection may be the major cause of liver disease in the United States. The use of alcohol may make the effects of Hepatitis C on the liver more severe.

"Our observations suggest a significant epidemic in an unsuspecting population with little regular access to health care," notes study author Harold H. Harsch, MD, Associate Professor of Psychiatry at the Medical College. "These individuals also form a large pool for the continued transmission of Hepatitis C to the general population. As this reservoir of virus increases, even what may be minor transmission channels, such as sexual activity, ear piercing and tattooing will become more significant."

The study screened cocaine users who volunteered for a study of how the brain reacts to cocaine. Of the 144 people screened, 47 were found to have Hepatitis C, while only seven tested positive for Hepatitis B and only two for HIV. Of the 144, 56% were African-American, 81% were male, 75% were never-married, and 55% were unemployed. The average age was 36. None of the subjects had ever received a blood transfusion.

Twenty-nine percent who tested negative for Hepatitis C reported intravenous drug use, while 77% of those testing positive for the disease reported IV drug use. Those who tested positive for Hepatitis C tended to be three to four years older than Hepatitis C-free patients.

One of the most surprising findings was that about 14% of those with Hepatitis C said they had never used intravenous drugs. This suggests that there are other ways for the spread of the disease among cocaine users, such as sharing straws to snort cocaine, particularly if nosebleeds occur. For Hepatitis C to be spread, the virus generally must enter the bloodstream through the skin or mucous membranes. Hepatitis C does not spread as easily through sexual contact as Hepatitis B or HIV.

A recent study of blood donors who tested positive for Hepatitis C found that intranasal cocaine use, sexual promiscuity, intravenous drug use, history of transfusion and ear piercing among men were risk factors.

It was only in the late 1980s that a test was developed to identify Hepatitis C. While screening for Hepatitis B and HIV has become routine at hospitals, drug centers and blood banks, Hepatitis C is sometimes overlooked. The Medical College study suggests it may be widespread among cocaine users, including those who smoke crack cocaine.

The Medical College study appeared in the June 2000 issue of Community Mental Health Journal. Co-authors of the study are John Pankiewicz, MD; Alan S. Bloom, PhD; Charles Rainey, MD; Jung-Ki Cho, MD; Lori Sperry, PhD; and Elliott A. Stein, PhD.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.