This study reveals that the seroprevalence of hepatitis C virus (HCV) is significantly higher among patients with alcohol dependence compared to the general population. It also analyzes susceptibility factors for hepatitis A (HAV) and hepatitis E (HEV), providing critical evidence for screening and prevention strategies in high-risk populations.
Literature Overview
The article titled 'Prevalence of Viral Hepatitis Antibodies Among Alcoholics in Croatia: A Single Center’s Results,' published in the journal Antibodies, reviews and summarizes the prevalence of serological markers for hepatitis A, B, C, and E viruses among 151 patients with alcohol use disorder treated at a clinical center in Croatia, comparing results with a control group of 110 individuals from the general population. The study employed serological and molecular biological methods to detect antibodies and viral RNA, further analyzing the impact of sociodemographic factors and drinking behaviors on HAV and HEV seropositivity. Results showed that HCV antibody positivity among alcohol-dependent patients was significantly higher than in controls, while no significant differences were observed for other hepatitis markers. Age, retirement status, and age at onset of alcohol use were associated with HAV seropositivity, while higher education was linked to a lower risk of HEV infection. The study underscores the importance of HCV screening in alcohol-dependent populations and highlights the potential value of HAV vaccination and HEV risk education.Background Knowledge
Viral hepatitis types A–E represent major global public health concerns. HAV and HEV are primarily transmitted via the fecal-oral route, whereas HBV and HCV are mainly spread through blood and bodily fluids. Chronic alcohol consumption can exacerbate liver damage in individuals with viral hepatitis, significantly increasing the risks of cirrhosis, liver failure, and hepatocellular carcinoma. Existing evidence suggests that people with alcohol use disorder often engage in high-risk behaviors (e.g., injection drug use, unprotected sex), which may elevate their risk of HBV and HCV infection. However, data on HAV and HEV prevalence in this population remain limited, especially in low- and middle-prevalence regions. Croatia is considered a low-to-moderate endemic area for HAV and HBV, and in recent years, improved sanitation has led to a declining trend in HAV seroprevalence. Nevertheless, specific high-risk groups, such as individuals with alcohol dependence, may face increased HEV exposure due to poor living conditions, inadequate hygiene, or dietary habits (e.g., consuming undercooked pork or game meat). Additionally, low vaccination coverage may further increase susceptibility. Therefore, understanding hepatitis prevalence in this population and identifying modifiable risk factors are crucial for developing targeted prevention strategies. This study fills a gap in multi-viral hepatitis seroprevalence data among alcohol-dependent individuals in Croatia, offering empirical support for public health interventions.
Research Methods and Experiments
The study enrolled 151 patients undergoing treatment for alcohol abuse at the University Hospital Centre 'Sestre Milosrdnice' in Zagreb, with a control group of 110 individuals from the general population. All participants were tested for antibodies and antigens against HAV, HBV, HCV, and HEV using serological methods. Antibody detection for HAV, HBV, HCV, and HEV was performed using commercial enzyme-linked fluorescent assays (ELFA), HCV RNA was detected via real-time PCR, and HEV antibody-positive samples were confirmed by immunoblotting. Researchers collected data on sociodemographic characteristics, alcohol history, and dietary habits using questionnaires. Statistical analyses included descriptive statistics, exact binomial tests, and univariate logistic regression models to assess associations between variables and HAV/HEV seropositivity. All analyses were conducted using R software, with a p-value < 0.05 considered statistically significant.Key Conclusions and Perspectives
Research Significance and Prospects
This study is the first in Croatia to systematically assess the combined seroprevalence of multiple hepatitis viruses among alcohol-dependent individuals, revealing a significant clustering of HCV infection and supporting routine HCV screening in this group. Additionally, the infection patterns of HAV and HEV are closely tied to sociodemographic factors, suggesting the need for enhanced health education and vaccination programs targeting this population. In particular, HAV vaccination should be integrated into standard preventive care in alcohol treatment centers to reduce the hepatic burden from co-infections. Furthermore, the protective effect of higher education against HEV infection suggests that improving health literacy could reduce infection risk.
Although the small sample size limits multivariate analysis and behavioral data from controls are lacking, the findings hold important public health implications. Future studies should validate these results in multicenter, larger cohorts and explore integrated management models combining vaccination, behavioral interventions, and antiviral therapy. Additionally, further research should investigate the impact of dietary habits, occupational exposure, and living environments on HEV infection to develop more precise prevention strategies.
Conclusion
This study found that in Croatia, individuals with alcohol use disorder have a significantly higher prevalence of hepatitis C virus (HCV) antibodies compared to the general population, identifying this group as being at high risk for HCV infection and warranting prioritization in screening and treatment programs. Although the seroprevalence of hepatitis A (HAV) and hepatitis E (HEV) did not significantly differ from controls, infection status was closely associated with age, retirement status, and education level. HAV seropositivity was linked to older age and later onset of alcohol use, reflecting cumulative lifetime exposure, while higher educational attainment significantly reduced HEV infection risk, likely due to better hygiene awareness and dietary practices. No individuals tested positive for HBsAg, but natural immunity to HBV was low, indicating vulnerability to infection. Overall, alcohol-dependent individuals face multiple threats from viral hepatitis, particularly HCV. Therefore, it is recommended to promote HAV vaccination in alcohol treatment settings, strengthen HCV screening, and enhance awareness of HEV risk factors through health education. Given the single-center, small-sample design, future multicenter, large-scale studies are needed to confirm these findings and explore integrated prevention and treatment models to improve liver health outcomes in this vulnerable population.
