Progression of liver fibrosis among injection drug users with chronic hepatitis C

Abstract

Although most hepatitis C virus (HCV) infections are acquired by injection drug use, prospective data on the progression of liver fibrosis are sparse. Baseline liver biopsies were obtained (1996-1998) on a random sample of 210 out of 1667 HCV-positive injection drug users (IDUs). Subjects were followed biannually, with a second biopsy offered to those eligible. Paired biopsies were scored 0 to 6 (modified Ishak score), significant fibrosis was defined as score 3 or greater, and progression of fibrosis was defined as an increase 2 or more units or clinical evidence of end-stage liver disease. Predictive values of blood markers [FibroSURE, aspartate aminotransferase-to-platelet-ratio index (APRI) and alanine aminotransferase (ALT)] were assessed for detection of contemporaneous and future liver fibrosis. Among 119 prospectively followed IDUs, 96% were African American; 97% HCV genotype 1a/b; 27% HIV-infected, and median age was 42 years. Most (90.7%) did not have significant liver fibrosis at first biopsy. Although predictive value for detecting insignificant fibrosis at first biopsy was greater than 95% for FibroSURE, APRI, and ALT, specificities were 88.9%, 72.7%, and 72.7%, respectively. After 4.2 years median follow-up, 21% had progression of fibrosis, which was significantly associated with serum level of HCV RNA and ALT. No serological test had predictive value greater than 40% for contemporaneous or future significant fibrosis. Even initial biopsy result had only a 30.4% value for predicting future significant fibrosis. In conclusion, significant liver fibrosis and progression were detected in some, but not most, IDUs in this cohort. In this setting with low fibrosis prevalence, FibroSURE, ALT, and APRI tests predict insignificant fibrosis; however, further work is needed to find noninvasive markers of significant liver fibrosis. (HEPATOLOGY 2006;43: 788-795.)

Human Immunodeficiency Virus-Related Microbial Translocation and Progression of Hepatitis C

“…22,42 We have also previously reported that liver enzyme values are lower when HCV-infected persons have been injecting in the preceding months. 43 Interestingly, we found that active injection drug use was associated with higher levels of protective EndoCAb IgM, which bind LPS.…”

Influence of Cannabis Use on Severity of Hepatitis C Disease

“…In our study, HCV viral load was the only factor with a statistically significant association with mild fibrosis compared to no fibrosis. Two recent paired biopsy studies of individuals with chronic HCV infection and predominantly mild fibrosis identified HCV viral load as an independent predictor of fibrosis progression (29,31). These results suggest that the relationship between HCV viral load and risk of fibrosis progression warrants reevaluation, with a focus on those persons with minimal or mild HCV disease.…”

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

“…Although these predictive values appear suboptimal, the NPV was more acceptable in lower prevalence settings, such as typically observed in community-based cohorts. 64 For example, at a prevalence of 30% to 40%, the estimated NPV ranged from 80% to 86%; at the same time, the PPV did not exceed 52% (Fig. 3).…”