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

Figures & data

Figure 1. Flowchart of included participants.

Table 1. Baseline demographics of included chronic hepatitis C (CHC) participants (n = 203) compared with non-included CHC participants (n = 761) at the Stockholm NEP during the study period.

	Included	Non-included
	n = 203	n = 761
	n (%)	n (%)
Gender
Females	50 (24.6)	171 (22.5)
Males	153 (75.4)	590 (77.5)
Age
Mean (years) / (SD)	44.0 (11.2)	42.3 (11.5)
Median (years) / (range)	45 (20–67)	41 (21–74)
Age (interval)
≥40	132 (65.0)	419 (55.1)
IDU duration		n = 748
Mean (years) / (SD)	21.8 (13.2)	20.6 (12.4)
Median (years) / (range)	21 (1–51)	19 (0–55)
IDU duration (interval)		n = 758
≥15	137 (67.5)	472 (63.1)
Main drug		n = 759
Amphetamine	118 (58.1)	332 (43.7)
Heroin	52 (25.6)	298 (39.3)
Other	33 (16.3)	129 (17.0)

Table 2. Association between baseline demographics and fibrosis stages classified as mild (F0–F2, LSM ≤9.4 kPa) versus advanced (F3–F4, LSM ≥9.5 kPa), (n = 203).

	Fibrosis stages		p value
	Mild	Advanced
	n = 172	n = 31
	n (%)	n (%)
Gender
Females	48 (27.9)	2 (6.5)	<.05
Males	124 (72.1)	29 (93.5)
Age (years)
≥40	104 (60.5)	28 (90.3)	<.001
IDU duration (years)
≥15	109 (63.4)	28 (90.3)	<.01
Self-reported risk use of alcohol (AUDIT-C)
No risk	115 (66.9)	19 (61.3)	.55
Risk	57 (33.1)	12 (38.7)
PEth (n = 191)
No risk	102 (63.4)	18 (60.0)	.74
Medium risk/High risk	59 (36.6)	12 (40.0)
Treatment of alcohol use disorder
Yes	22 (12.8)	2 (6.4)	.31
No	150 (87.2)	29 (93.5)
Diabetes mellitus
Yes	5 (2.9)	1 (3.2)	.92
No	167 (97.1)	30 (96.8)
BMI (n = 201)
<30	159 (92.4)	28 (90.3)	.52
≥30	11 (6.4)	3 (9.7)
Previous HCV treatment
Yes	10 (5.8)	4 (12.9)	.24
No	162 (94.2)	27 (87.1)
APRI (n = 190)^a
≥1	14 (8.1)	9 (30.0)	<.01
≥2	3 (1.7)	4 (13.3)	<.05
FIB-4 (n = 190)^a
<1.45	110 (68.8)	8 (26.7)	<.001
1.45–3.25	46 (28.8)	13 (43.3)
>3.25	4 (2.5)	9 (30.0)

^a13 missing, 10 in F0–F1, 2 in F2 and one in F4.

Figure 2. (a) The APRI score according to fibrosis stage F0–F2 mild fibrosis (LSM ≤9.4 kPa) and F3–F4 advanced fibrosis (LSM ≥9.5 kPa). A significant difference in APRI score was seen in participants with mild versus advanced fibrosis, p < .0001. (b)The APRI score according to fibrosis stage F0–F3 (no cirrhosis, LSM ≤12.4 kPa) and F4 (cirrhosis, LSM ≥12.5 kPa). A significant difference in APRI score was seen in participants with and without cirrhosis, p < .001.

Figure 3. Advanced fibrosis (fibrosis stage F3–F4, LSM ≥9.5 kPa) and mild fibrosis (fibrosis stage F0–F2, LSM ≤9.4 kPa) plotted against age and IDU duration with cut-offs by age ≥40 years and IDU duration ≥15 years (dotted lines).

Table 3. Accuracy testing of possible cut-offs for detecting advanced fibrosis (LSM ≥9.5 kPa).

	Age ≥40	IDU ≥15	Age ≥40 + IDU ≥15	APRI >1	FIB-4 > 3.25
Percentage of participants	65.0%	67.5%	56.2%	12.1%	6.8%
Sensitivity	90.3%	90.3%	83.9%	42.9%	42.9%
Specificity	39.5%	36.6%	48.8%	91.3%	97.5%
PPV	21.2%	20.4%	22.8%	39.1%	81.8%
NPV	95.8%	95.5%	94.4%	87.4%	88.1%