Hepatic Disease

The IVDU may develop liver disease, including cirrhosis, from both parenterally and sexually transmitted hepatitis A, B, C, and G virus as well as the delta virus. 4314, and 45 It is estimated that over 80 percent of IVDUs have had hepatitis, with the majority of reported cases due to hepatitis B and C. These patients frequently progress to chronic active hepatitis with a high mortality. When an IVDU patient presents with the clinical syndrome of acute hepatitis, appropriate laboratory testing includes serum transaminases, bilirubin levels, alkaline phosphatase, prothrombin time, and serologic testing. If other significant disease can be excluded, most can be managed as outpatients. Admission criteria include inability to tolerate oral intake, toxicity, and prolonged prothrombin time with bleeding. Patients should be counseled on both sexual contact and needle exposure and should be encouraged to inform all sexual and needle partners and household contacts of exposure. Seronegative patients should receive hepatitis B and A immunization. 4344

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