Factors associated with fulminant liver failure during an outbreak among injection drug users with acute hepatitis B

Hepatology : Official Journal of the American Association for the Study of Liver Diseases
Richard S GarfeinBeth P Bell

Abstract

Death related to acute hepatitis B occurs in approximately 1% of patients. We investigated an outbreak of hepatitis B virus (HBV) infections among injection drug users (IDUs) resulting in several deaths. We conducted a case-control study of fulminant (case patients) and nonfulminant (control patients) HBV infections. We directly sequenced the entire HBV genome from fulminant and nonfulminant cases. From October 1998 to July 2000, 21 acute HBV infections, including 10 fulminant hepatitis B cases, were identified. The median age was 30 (range, 18-49) years, 12 (57%) were female, 20 (95%) were American Indians, and 20 (95%) reported injecting illicit drugs. All patients with fulminant hepatitis B died (case-fatality rate = 47.6%). Case patients (n = 5) and control patients (n = 9) were similar with respect to age, sex, race, and hepatitis C virus serostatus. All case patients used acetaminophen during their illness compared with 44% of control patients (P =.08). Compared with control patients, case patients lost more weight in the 6 months before illness (P =.04); during their illness, they used more alcohol (P =.03) and methamphetamine (P =.04). All 9 isolates sequenced were genotype D, shared 99.7% homology, and included mutatio...Continue Reading

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