Dear Sir,
A recent paper in your journal 1[1] highlights the prevalence of hepatitis C infection in a community-based programme for adult opiate users. There are however significant differences in the prevalence of viral infection in adolescent treatment programmes and these differences have clinical implications for young people. The Young Persons Programme (YPP) in Cherry Orchard Hospital is a community-based programme, which provides services for adolescent drug users. The case notes of 54 young people who presented to this programme between 1998 and 2001 were examined. The prevalence of Hep C antibody among these young people was only 27%. This contrasts with the prevalence of 74% in the community based adult programme reported in your journal. The low prevalence of Hepatitis C infection in the YPP is due to the high (64%) percentage of adolescent patients who were still smoking heroin rather than injecting it. Among declared injectors in the YPP the prevalence of Hep C antibodies (55%) was closer to the adult figure. The mean duration of injecting for Hep C antibody positive patients was 1.42 years and for Hep C antibody negative patients it was 1.16 years. In other words infection did not immediately follow the switch to injecting in all cases. The prevalence of Hepatitis B infection and HIV was comparable to the adult programme. Young smokers at high risk of becoming young injectors and developing hepatitis C infection. However, few young people set out to inject and generally only switch to injecting when they have developed a relatively high degree of tolerance. It is more difficult to alter risk-taking behaviour at that stage, and exposure to viral infection is then more likely. This suggests that more efforts to limit Hepatitis C infection as a consequence of intravenous drug use should be targeted towards young people who are still smoking heroin, before they develop tolerance and switch to injecting and also towards young people who have just begun to inject. Young people require information and education before they come into contact with established drug treatment programmes, through outreach, community programmes and public information. Young drug users and the agencies they attend need to know that the prevalence of infection is much lower among young people than in the adult population and that it is still possible for many of them to avoid infection. The figures also highlight the necessity for adequate long-term medical follow-up of young people who go on to become infected with Hepatitis C. Yours sincerely,
John Moloney,
Young Persons Programme, Fortune House,
Cherry Orchard Hospital, Dublin 22 References - [1] High morbidity expected from cirrhosis in injecting drug users. Kavanagh, Moloney &al. Ir Med J 2003 Nov-Dec; 96(10): 303-5
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