FibroScan used in street‐based outreach for drug users is useful for hepatitis C virus screening and management: a prospective study

Abstract

Although hepatitis C virus (HCV) infection prevalence is high among drug users, they do not commonly receive regular care in academic centres. The aim of this prospective study was to assess the influence of FibroScan use on HCV screening and management in street-based outreach. From January 2006 to January 2007, all consecutive drug users were offered noninvasive evaluation of liver fibrosis with FibroScan. After FibroScan, parameters were recorded with a structured, face-to-face questionnaire by outreach workers. All 298 subjects accepted FibroScan evaluation drug use was--ever injected heroin (69%), ever snorted or injected cocaine (89%), current chronic alcohol abuse (44%). The median FibroScan score was 5.3 kPa. Before blood sampling, 34% of subjects reported HCV positivity. HCV positivity was found in 83 cases. All these subjects had positive HCV-RNA. Forty-five subjects agreed to meet a hepatologist. By multivariate analysis, never snorted cocaine, consumed alcohol < 21 drinks per week, duration of injected heroin > 7 years, and FibroScan > 7.1 kPa were significantly associated with HCV positivity. Thus in a street-based outreach service for drug users, the acceptance of FibroScan is excellent. FibroScan with a hospital-based physician may facilitate screening and management of drug users for HCV infection.

Transient elastography for the diagnosis of liver fibrosis

“…Recently, liver stiffness measurement using FibroScan was evaluated in a street-based outreach for drug users. All consecutive drug users in two street-based outreaches were offered non invasive evaluation of liver fibrosis with a FibroScan [74]. Of the 298 patients included in this study, all of them (100%) accepted liver stiffness assessment.…”

Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs

“…In one study of a liver health promotion campaign using transient elastrography-based assessment among PWID in drug and alcohol clinics by Marshall et al, 95% reported that transient elastography was an acceptable method of liver disease assessment (Marshall, this issue). Transient elastography has been shown to be effective for enhancing liver disease screening among PWID attending drug and alcohol clinics in other settings (Foucher et al, 2009;Moessner et al, 2011). Increased community-based liver disease screening using transient elastrography might be one useful strategy for linking PWID in HCV care and triaging those with advanced liver disease who are in most need of immediate treatment.…”

Management of HCV and HIV infections among people who inject drugs

“…FibroScan-based assessment utilizes an ultrasound-based technique to measure liver stiffness, having good diagnostic accuracy for distinguishing cirrhosis from mild disease. In Denmark [62 ] and France [63], FibroScan-based liver assessment at addiction clinics was a feasible strategy to screen for liver disease and HCV.…”