Stage of Liver Disease in Hepatitis C Patients at a Low-Threshold Hepatitis C Clinic in Oslo

Author: Dalgard O, Backe Ø, Vennesland K, Ulstein, Wüsthoff LE

Theme: Epidemiology & Public Health Research Year: 2016


Dalgard O1,2, Backe Ø3, Vennesland K3, Ulstein K3, Wüsthoff LE3

1University of Oslo, 2Akershus University Hospital, 3 Agency for Social and Welfare Services, City of Oslo

Introduction: The natural history of chronic hepatitis C (HCV) infection is highly variable and not well described among people who inject drugs (PWID). The aim of this study is to determine the proportion of patients with liver cirrhosis among PWID seeking care at a lowthreshold HCV clinic. Secondary aims were to identify predictors of cirrhosis.

Methods: Consecutive patients seen at a low-threshold HCV clinic in Oslo were included if they were HCV RNA positive, had a valid liver elasticity (LE) evaluation performed and had not received HCV treatment. LE evaluations were considered reliable if they included ≥10 valid measurements with ≥60% success rate, and an interquartile range/median LE (IQR/M) of ≤0.30%. Cirrhosis was diagnosed if LE was ≥12.5 kPa.

Results: We included 122 patients. The mean age was 46 years (range 21-63) and 87 (71.3%) were men. Genotype 1 was present in 51 (42%), genotype 2 in 13 (11%) and genotype 3 in 58 (47%). Recent injection was reported by 86 (70.5%) patients and 74 (60.7%) were on opiate substitution treatment (OST). Harmful alcohol consumption was reported by 19 (15.6%). The median LE was 6.8 kPa (range 3.3 ->75) and cirrhosis was diagnosed in 24 (19.7%). The proportion with cirrhosis increased according to age (7.1%, 19.6% and 27.1% in those <40 years, 40-49 years and ≥50 years, respectively, (p=0.038) and was higher in those with genotype 3 than those with a non-3 genotype (12.5% and 30.2%, respectively) (p=0.017). In a multivariate analysis with cirrhosis as dependent variable and gender, age, genotype (3 vs non-3) and alcohol consumption (high vs low) as independent variables the presence of genotype 3 was the only predictor of cirrhosis (p=0.022). Conclusion: Among PWID in Oslo with chronic HCV infection cirrhosis was present in 20%. The risk of cirrhosis was higher in those with genotype 3. Disclosure of Interest Statement: Liver elasticity was measured with Fibroscan ® donated to the Salvage Army in Oslo by Abbvie

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