Hepatitis C virus (HCV) related liver fibrosis in people who inject drugs (PWID) at the Stockholm Needle Exchange – evaluated with liver elasticity

Abstract

Background and aims: Sharing of unsterile injection equipment among people who inject drugs (PWID) is the major transmission-route for hepatitis C (HCV). HCV is highly prevalent in PWID in the Stockholm needle exchange programme (NEP). The frequency of advanced liver fibrosis among the participants is, however, unknown.

Methods: From December 2016 to April 2018, all participants with chronic hepatitis C infection (CHC) were offered liver fibrosis evaluation at the Stockholm NEP, including liver stiffness measurement (LSM), a medical history and expanded blood tests to evaluate APRI and FIB-4 scores.

Results: A total of 2037 individuals were enrolled of whom 964 (47.3%) had CHC. LSM was performed in 203 (21.1%) of eligible participants of whom 85% had mild fibrosis (LSM ≤9.4 kPa) and 15% advanced fibrosis (LSM ≥9.5 kPa). APRI >1 and FIB-4 > 3.25 only identified 30% of participants with advanced fibrosis. However, all 31(100%) participants with advanced fibrosis were detected when APRI >1 was combined with an age of ≥40 years and an injection drug use (IDU) duration of ≥15 years.

Conclusions: We found that the diagnostic work-up for advanced fibrosis can be simplified with this combination of easily available factors. This allows identification of PWID in need of immediate HCV treatment to prevent further disease progression. Furthermore, LSM can be avoided among PWID with mild fibrosis, identified by age <40 years combined with IDU duration of <15 years and APRI score <1. This strategy enhances the HCV care cascade where LSM is not easily available, and will thus facilitate HCV treatment initiation.

Keywords:

• Hepatitis C
• PWID
• needle exchange programmes
• non-invasive techniques

Acknowledgements

The help from the clinical staff at the Stockholm NEP in terms of data collection is highly appreciated. The authors especially thank the nurses, Ann-Marie Lang and Linda Näslund.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Gilead Sciences Inc. supported the operational lease of a FibroScan^® at the Stockholm NEP during two years with start in December 2016. This study was funded by research grants from Stockholm County Council and by Gilead Nordic Fellowship 2015 and 2016 . The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.