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The hepatitis C virus (HCV) is a common infection among injecting drug users. There are currently few available data on the extent (or prevalence) of HCV-related discrimination. This study examined perceived discrimination among a sample of heroin users and sought to determine whether the discrimination was attributed to their drug user or HCV status. Heroin users were recruited through needle and syringe programmes and methadone clinics in Sydney and were asked about discrimination in the preceding 12 months. Four hundred and one heroin users were recruited, of whom 59% reported being HCV-positive. Discrimination was reported by 22% of the 237 IDUs who reported being HCV-positive, with 17% reporting that the discrimination occurred in the preceding 12 months. Sixty-seven incidents were reported, of which half were perceived to be due to their drug user status, 15% of these incidents were due to HCV status and 25% due to a combination of both. Twenty-five incidents occurred in a health-care setting, of which 13 resulted in the service being withheld. HCV is a serious public health concern, and if IDU are to be encouraged into drug treatment it is essential that service providers are perceived to be non-discriminatory. In managing IDU patients, health care workers need to be cognisant of the impact that their attitude has on treatment outcome. [Day C, Ross J, Dolan K. Hepatitis C-related discrimination among heroin users in Sydney: drug user or hepatitis C discrimination? Drug Alcohol Rev 2003;22:317 - 321] [ABSTRACT FROM AUTHOR]

AbstractBackground: The clinical usefulness of the ratio of serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) has been explored in several liver disorders. It has been suggested that in patients with chronic hepatitis C virus (HCV) infection an AST: ALT ≥ 1 has 100% specificity and positive predictive value in distinguishing cirrhotic from non-cirrhotic patients. Such statistical certainty attached to a simple biochemical test merits further evaluation. The present study, therefore, assessed the AST: ALT in patients with chronic HCV infection to determine the validity of the ratio in predicting cirrhosis and to correlate the ratio with the histological grade of necroinflammatory activity and fibrosis. Methods: A retrospective analysis of 153 patients with chronic HCV infection was conducted. Serum biochemistry had been obtained within a mean of 4 weeks of liver biopsy. The histology was scored in terms of activity and fibrosis as described by Scheuer and correlated with AST: ALT. Results: In 30 patients with cirrhosis, the mean AST: ALT (0.99 ± 0.06) was higher than in 123 patients without cirrhosis (0.60 ± 0.02; P < 0.001). A ratio ≥ 1 had 95.9% specificity and 73.7% positive predictive value in distinguishing cirrhotic from non-cirrhotic patients, with a 46.7% sensitivity and 88.1% negative predictive value. The ratio also parallelled the Scheuer score with respect to fibrosis but not with respect to inflammation. Conclusion: Although relatively insensitive, an AST: ALT ≥ 1 is highly specific but not diagnostic for the presence of cirrhosis in patients with chronic HCV infection. The ratio reflects the grade of fibrosis in these patients. [ABSTRACT FROM AUTHOR]