Chronic hepatitis C in Swedish subjects receiving opiate substitution therapy--factors associated with advanced fibrosis

Autor:	Martin Lagging, Johan Kakko, Christian Simonsberg, Anders Widell, Jan Frimand, Per Björkman, Christer Lidman, Anna Jerkeman, Johan Westin, Gunnar Norkrans
Rok vydání:	2014
Předmět:	Microbiology (medical) Adult Liver Cirrhosis Male Infectious Medicine medicine.medical_specialty Cirrhosis Hepatitis C virus medicine.disease_cause Chronic liver disease Young Adult Internal medicine medicine Opiate Substitution Treatment Humans Hepatitis B virus Sweden General Immunology and Microbiology medicine.diagnostic_test business.industry General Medicine Hepatitis C Hepatitis C Chronic Middle Aged medicine.disease Opioid-Related Disorders Infectious Diseases Liver biopsy Cohort Immunology Female business Body mass index
Zdroj:	Scandinavian Journal of Infectious Diseases; 46(5), pp 340-347 (2014)
ISSN:	1651-1980
Popis:	Background: Opiate substitution therapy (OST) reduces the risk of death from directly drug-related causes in heroin users, allowing other chronic health problems to emerge. People who inject drugs (PWID) are exposed to hepatitis C virus (HCV), with an associated risk of chronic liver disease. We investigated HCV prevalence and liver-related morbidity in a cohort of OST recipients, and analyzed factors associated with significant hepatic fibrosis. Methods: All patients registered on 1 April 2008 in 4 clinics providing OST in the 3 largest cities in Sweden were eligible for inclusion. HCV viremic subjects were evaluated for fibrosis stage by liver biopsy, transient elastometry (TE), and/or a biochemical fibrosis index (Goteborg University Cirrhosis Index; GUCI). Factors associated with severity of fibrosis were determined by logistic regression analysis. Results: Out of 524 eligible patients, 277 consented to enrolment. Two hundred and thirty-six subjects (88%) were anti-HCV-positive, and 162 of these were viremic (69%). Significant liver fibrosis (defined as Ishak stages F3-F6, TE value ≥ 8.85 kPa, or GUCI > 0.33) was found in 69 out of 103 (67%) tested viremic patients, and was associated with alcohol intake (p = 0.03), higher body mass index (BMI; p = 0.04), and the presence of anti-HBc antibodies (indicating exposure to hepatitis B virus (HBV); p = 0.02). Conclusions: Significant liver fibrosis was detected in two-thirds of HCV viremic OST recipients in this cohort, and was associated with alcohol use, high BMI, and exposure to HBV. These findings indicate that the management of HCV and associated risk factors should be emphasized in Swedish OST programs. (Less)
Databáze:	OpenAIRE
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