Severity and correlates of liver disease in hepatitis C virus-infected injection drug users

Abstract

members of a cohort of 1,667 hepatitis C virus (HCV)-infected injection drug users (IDUs) were selected for liver biopsy procedure after stratification based on 2 consecutive serum alanine transaminase (ALT) levels. Liver histology, which could be fully evaluated for 207 subjects, was classified by using the modified Ishak scores. At the time of biopsy, the median age of subjects was 41.3 years and the median estimated duration of HCV infection was 20.7 years; 94% were African American; 78% men; 31% were human immunodeficiency virus (HIV) seropositive; and 76% had HCV genotype 1a or 1b. Total modified histologic activity index (MHAI) scores ranged from 0 to 9, and 26.6% had a total MHAI score of 5 or greater. Persons with a total MHAI score of 5 or greater were more likely to be HIV infected (P ‫؍‬ .04). Higher fibrosis, indicated by Ishak modified fibrosis scores of 3 to 6, was present in 10.1% of subjects and was found more often in those older than 46 years of age (the highest quartile) (P < .01). Both fibrosis scores of 3 or greater and total scores of 5 or greater were associated with elevated ALT, aspartate transaminase (AST), and ␥-glutamyl transpeptidase (GGT) levels (P < .01). When serial values were considered, the results of liver enzyme testing could reduce the probability of an IDU having a fibrosis score of 3 or greater from 10% to 3%. In conclusion, these data indicate that severe liver disease is uncommon in this urban, HCV-infected IDU cohort, especially in younger persons and those with repeatedly normal liver enzymes. (HEPATOLOGY 2002;35:1247-1255

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

“…9 Between May 1996 and June 1998, a cross-sectional study was performed to determine the severity and correlates of clinically silent liver disease among members of the HCV-infected IDU cohort. 10 Two hundred ten subjects were randomly selected from eligible participants after stratification for serum alanine aminotransferase (ALT) level, as previously described. 10 Candidates were offered enrollment in the biopsy substudy by a single study coordinator and examined by a hepatologist.…”

“…10 Two hundred ten subjects were randomly selected from eligible participants after stratification for serum alanine aminotransferase (ALT) level, as previously described. 10 Candidates were offered enrollment in the biopsy substudy by a single study coordinator and examined by a hepatologist. A questionnaire was administered a median of 8 days before each biopsy to assess medical information and drug/alcohol-using behavior.…”

“…Subjects were excluded from the initial biopsy study if they already had clinical evidence of end-stage liver disease (defined as ascites, encephalopathy, unexplained prothrombin time Ն14 seconds or esophageal varices) or had a serious non-liver-related medical condition, as previously described. 10 Subjects were not excluded if they had hepatitis B; however, HBV DNA was only detected in one subject using the Roche COBAS PCR (Roche Molecular Systems, Basel, Switzerland). 12 Prospective Biopsy Group.…”

“…9 To further evaluate the magnitude of clinically silent liver disease, we performed a liver biopsy on randomly selected cohort members between 1996 and 1998. 10 The chief purposes of the current investigation are: (1) to assess prospectively the rate of the progression of liver fibrosis among HCV-infected IDUs by repeating liver biopsies 3 to 5 years later and (2) to identify persons at risk for progression (in need of treatment) by using noninvasive testing.…”

Liver fibrosis progression at autopsy in injecting drug users infected by hepatitis C: A longitudinal long-term cohort study

“…In Western countries the main cause of HCV-infection has been the use of contaminated syringes and needles among IDUs. Still, to the best of our knowledge few longitudinal long-term studies have been published with IDUs as the main subjects, and most have used a limited observation time [8][9][10]. There is a number of crossectional studies of HCV related fibrosis [11].…”