Stimulated by Hyun et al 2023.[1]
SR – systematic review
key to acronyms
DAA – direct acting antiviral
RR – relative risk
AE – adverse event
This is a new topic for the blog, but one with considerable global significance. Readers in the UK and countries with similar standards aimed at preventing bloodborne transmission of infection need not panic. As long as you are following the standard procedures to avoid hepatitis B transmission, you will also avoid hepatitis C, both in terms of acquisition and transmission to your patients.
So, whilst acupuncture is unlikely to be a significant risk factor for acquiring hepatitis C in the UK, from a global perspective it looks as though it is a factor we should consider.
This paper is an SR of 28 studies including just under 200k participants that investigates the association of acupuncture and the risk of acquiring hepatitis C.
Hepatitis C is inflammation of the liver caused by the hepatitis C virus. The virus can cause both acute and chronic hepatitis. It can vary in severity from a mild illness to a serious lifelong condition ending in death from cirrhosis or hepatocellular carcinoma. It is transmitted by exposure to infected blood through unsafe injection practices, unscreened blood transfusions and unsafe sexual practices. In 95% of cases, it is treatable with DAAs, but access to screening, diagnosis and treatment is very low globally.[2]
The WHO estimates that 58 million people have chronic hepatitis C and that 290 000 people died of the consequences of this infection in 2019.[2]
This is the first SR to look exclusively at acupuncture and hepatitis C risk. Previous reviews have considered tattooing and transfusions as well as acupuncture. The studies come from all over the world including the US and China, with just 4 from Europe.
The bottom line is that there seems to be an increased risk with a pooled RR of 1.83 associated with acupuncture use.
Having tattoos appears to be associated with a greater risk (~5x) unless you restrict your view to those customers of professional tattoo parlours. I suspect the same is likely to be true for professional acupuncture provision, particularly where the profession restricts members to the use of sterile disposable needles and prohibits reuse of needles. This is probably one good argument for regulation of acupuncture, but the limited regulation of acupuncture that occurs at local authority level in the UK is likely to be sufficient to mitigate this risk.
Whilst on the subject of the liver and AEs, I saw a rather dramatic set of images recently. It was from a case report of acute haemoperitoneum resulting from percutaneous liver injury secondary to acupuncture.[3] The full text is not yet available, but no doubt will be soon (from here), and hopefully before Wednesday evening.
References
1 Hyun MH, Kim JH, Jang JW, et al. Risk of Hepatitis C Virus Transmission through Acupuncture: A Systematic Review and Meta-Analysis. Korean J Gastroenterol. 2023;82:127–36.
2 Hepatitis C. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 2 October 2023)
3 Seah EZ. Traditional Chinese Acupuncture Causing Acute Hemoperitoneum from Direct Liver Injury. J Radiol Case Rep. 2023;17:15–20.
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