Estimated Liver Fibrosis and its Impact on All-Cause Mortality of HCV-Monoinfected and HCV/HIV-Coinfected Drug Users

A.      Sanvisens; D.      Fuster; I.      Serra; J.      Tor; C.      Tural; C.      Rey-Joly; R.      Muga

Abstract

Progression of liver fibrosis is associated with the risk of cirrhosis and end-stage liver disease. We aimed to evaluate fibrosis of the liver using three non-invasive indexes (FIB-4, Forns, and Pohl score) and its association with mortality of HCV-monoinfected and HCV/HIV-coinfected drug users.

Patients and Methods: longitudinal study in patients admitted to substance abuse treatment between 1994 and 2006. Socio-demographic data, drug use characteristics, blood samples for laboratory tests, and serology for HIV and hepatitis C virus infections were collected at admission. Patients were followed-up until December 2006 and mortality was ascertained through hospital charts and death certificates.

Results: Four hundred and ninety-seven patients were included (83.1% men); median age at admission was 31 years (IQR: 27-35 years). The main drugs of abuse were opiates (89.5%) and cocaine (8.3%). Thirty-two percent of patients reported daily alcohol consumption. The estimated prevalence of advanced liver fibrosis (ALF) was higher among HCV/HIVcoinfected patients (9.2% to 17.3% depending on the index analyzed) than among the HCV-monoinfected patients (3% to 3.5%). Odds ratio (OR) for ALF were 3.3 to 6.0 times higher in coinfected patients as compared to the HCVmonoinfected. After a median follow-up time of 7.7 years (IQR: 4.1-9.9 years), almost 20% of patients had died. The estimated ALF at admission was associated with an increased risk of death (RR 1.85 to 3.89 depending on the index). Among those with ALF, mortality rates were similar in HCV-monoinfected and HCV/HIV-coinfected patients, as determined by the FIB-4 and Forns indexes.

Conclusions: Estimation of liver fibrosis using serum markers may help with clinical decisions to facilitate access to treatment of chronic hepatitis C in this population.

Keywords: Chronic hepatitis C, HIV infection, liver fibrosis, non-invasive index, mortality, hepatitis C, HCV infection, HCV/HIV-Coinfected Patients, Pohl Score