Multiple hepatitis attacks in drug addicts

Radioimmunoassays for detection of hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), antibody to hepatitis A virus (anti-HAV), and anti-HAV of IgM class were used to verify hepatitis A and hepatitis B infection in 33 drug addicts with multiple attacks of hepatitis. Hepatitis A was confirmed serologically in 23 (32%) of 71 total hepatitis episodes, while hepatitis B was confirmed in 30 episodes (42%). The remaining 18 hepatitis episodes (25%) were, by serological exclusion, also of Epstein-Barr virus and cytomegalovirus infection, classified as hepatitis non-A, non-B. However, while as many as 13 (39%) of the 33 primary attacks of hepatitis were of the type non-A, non-B, this type was never observed as a third attack. In no case were two attacks of hepatitis A or hepatitis B demonstrated in the same individual, but two different episodes of hepatitis non-A, non-B were observed in one patient. The maximal serum levels of alanine aminotransferase and bilirubin were significantly lower in patients with hepatitis non-A, non-B as compared with those with hepatitis B. Development of chronic liver disease occurred in only two (7%) of the 28 addicts who continued to be followed up.