Is it time for Parkinson's patients to pay attention to Hepatitic C Infection?
Counseling Your Hepatitis B and C Patients About the Potential for Parkinson’s Disease
Pakpoor and colleagues performed a retrospective cohort study from 1999–2011utilizing English National Hospital episode statistics and mortality data. The inclusion criteria were broad capturing hepatitis B, hepatitis C, autoimmune hepatitis, chronic active hepatitis, and HIV. “The standardized rate ratio of PD following hepatitis B was 1.76 (95% confidence interval [CI] 1.28–2.37) (p , 0.001), based on 44 observed compared with 25 expected cases. The rate ratio of PD following hepatitis C was 1.51 (95% CI, 1.18–1.9) (p , 0.001), based on 48.5 expected and 73 observed cases. The relative ratio for hepatitis B and hepatitis C were 1.82 (1.29–2.5) and 1.43 (1.09–1.84).”
The data suggests that both hepatitis B and C infection are associated with an increased risk of the later development of Parkinson’s disease. The finding applied only to only viral cases of hepatitis (excluding HIV), and though the authors could not be sure it was unlikely that the cause was antiretroviral therapy. The data agrees with previous reports on hepatitis C, however the association with hepatitis B is new and conflicts with the recent study from Taiwan. Data from more countries will be required to confirm the hepatitis B finding. Patients with hepatitis B and C should be counseled about the associated risks as well as the symptoms indicating a possible diagnosis of Parkinson’s disease. If a patient is potentially symptomatic for Parkinson’s, a referral to a neurological specialist would be appropriate. No data exists to support earlier treatment of hepatitis to prevent the later development of Parkinson’s disease.
Dr. Okun is Associate Editor of Journal Watch Neurology and all of his summaries are available on their website.
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