BACKGROUND AND OBJECTIVE:
We
characterize the burden of liver disease in a cohort of PWID in Chennai, India,
with a high prevalence of HCV.
MATERIALS AND METHODS:
1,042
PWID were sampled through community outreach in Chennai. Participants underwent
fasting blood draw, questionnaire and an examination that included liver
stiffness assessment using transient elastography (Fibroscan) and assessment of
steatosis via ultrasound.
RESULTS:
The median
age was 39 years, all were male, 14.8% were HIV infected and 35.6% were HCV
antibody positive, of whom 78.9% were chronically infected (HCV RNA positive).
Median liver stiffness was 6.2 kPA; 72.9% had no evidence of or mild stiffness,
14.5% had moderate stiffness, and 12.6% had evidence of severe
stiffness/cirrhosis. Prevalence of severe stiffness/cirrhosis was significantly
higher among persons who were older, had a longer duration of injecting drugs, higher
body mass index, higher prevalence of insulin resistance, higher prevalence of
steatosis, higher HCV RNA levels and evidence of alcohol dependence. An
estimated 42.1% of severe stiffness/cirrhosis in this sample was attributable
to HCV. 529 (53.0%) had some evidence of steatosis. Prevalence of steatosis was
higher among those who had larger waist circumference, insulin resistance,
higher HDL cholesterol and a history of antiretroviral therapy.
CONCLUSIONS:
We
observed a high burden of liver disease in this relatively young cohort that
was primarily driven by chronic HCV infection, metabolic factors (insulin
resistance and steatosis) and heavy alcohol use. Interventions to improve
access to HCV treatment and reduce alcohol use are needed to prevent further
progression of liver disease.
Below: Distribution of liver stiffness by HIV and HCV status
Below: Population attributable fractions of severe liver stiffness/cirrhosis among total population and persons with chronic HCV infection
By: Solomon SS1,2,3, Srikrishnan AK3, McFall AM2, Kumar MS3, Saravanan S3, Balakrishnan P3, Solomon S3, Thomas DL1, Sulkowski MS1, Mehta SH2.
- 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
- 3YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
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