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

Journal article
Authors A. Jerkeman
Johan Westin
Martin Lagging
Gunnar Norkrans
C. Lidman
J. Frimand
C. Simonsberg
J. Kakko
A. Widell
P. Björkman
Published in Scandinavian Journal of Infectious Diseases
Volume 46
Pages 340-347
ISSN 0036-5548
Publisher Informa Healthcare
Publication year 2014
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 340-347
Language en
Keywords Hepatitis C, Liver fibrosis, Opiate substitution therapy, Risk factors, amphetamine, antivirus agent, aspartate aminotransferase, buprenorphine, cocaine, diamorphine, methadone, prothrombin, abdominal discomfort, adult, alcohol abuse, alcohol consumption, antiviral therapy, article, body mass, disease severity, echography, female, Hepatitis B virus, hepatomegaly, human, human tissue, international normalized ratio, liver biopsy, liver cell carcinoma, liver cirrhosis, major clinical study, male, opiate addiction, opiate substitution treatment, risk factor, splenomegaly, Sweden, thrombocyte count
Subject categories Immunology in the medical area, Infectious Medicine


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 (Göteborg 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. © 2014 Informa Healthcare.

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