Dr Delbanco: Mr E is a 47-year-old married man. In 1992, while in prison, he was found to have asymptomatic hepatitis C infection. Currently he works part-time through a temporary agency. He does not have health insurance, but receives care at an inner-city neighborhood health center.
Mr E has been in good medical health except for a long history of substance abuse. At 19 years of age he began to experiment with marijuana, followed thereafter by the use of heroin intravenously, "uppers and downers," and cocaine. He denies using drugs in the past 3 months since leaving prison. He has used little alcohol over the years, drinking one or two beers about twice a month. He has smoked for many years and currently smokes 1½ packs per day.
In 1991 he tested positive for syphilis and received a series of six injections of a penicillin preparation. In 1992 he took
Sorrell MF. A 47-Year-Old Man With Asymptomatic Hepatitis C Infection. JAMA. 1996;275(13):1023-1029. doi:10.1001/jama.1996.03530370061032