Prevalence of hepatitis C infection in a large urban hospital-based sample of individuals with spinal cord injury.

OBJECTIVE

To examine the prevalence and clinical characteristics of hepatitis C infection in individuals with chronic spinal cord injury (SCI).

DESIGN

Retrospective case survey.

SETTING

Outpatient clinic devoted to SCI follow-up care located in a county-government rehabilitation center.

PARTICIPANTS

A total of 531 unselected individuals with chronic SCI.

INTERVENTIONS

Patients underwent routine annual physical examinations at the outpatient clinic, and were tested for hepatitis C antibodies, antibodies to hepatitis core antigen, alanine aminotransferase (ALT), and bilirubin.

MAIN OUTCOME MEASURES

Prevalence of hepatitis C antibodies and liver test abnormalities.

RESULTS

Seventeen percent of the cohort was anti-hepatitis C virus (HCV) reactive (HCV positive). The prevalence of HCV infection in those who sustained SCI before 1990 was 21% compared with 7% (10/147) of those who were injured from 1990 onward (, P=.0002). Period of injury (Wald, P=.0042) and age (Wald, P=.048) were the only significant factors for anti-HCV reactivity. Thirty percent of the HCV-positive individuals had abnormal ALT levels compared with only 10% of the HCV-negative individuals (, P<.0001). Individuals who were HCV positive were more likely to be hepatitis B core antigen-reactive compared with those who were HCV negative (31% vs 9%;, P<.0001).

CONCLUSIONS

The prevalence of HCV infection among individuals with chronic SCI is significantly higher than the general population. The majority of those with SCI and HCV infection have normal liver tests. Clinicians should maintain a high index of suspicion for HCV infection, even in the absence of elevated aminotransferase activities.