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Natural history of Hepatitis C Acquired through Injection Drug Use

SUMMARY: About 15% of individuals who contract chronic hepatitis C virus (HCV) infection through injection drug use develop liver cirrhosis over 20 years, according to a meta-analysis described in the August 2010 Journal of Hepatology. Injection drug user populations with a higher proportion of men and more people who drink alcohol experienced faster liver disease progression on average, but this was not seen with HIV/HCV coinfected people.

By Liz Highleyman

Injection drug users (IDUs) often contract blood-borne diseases such as hepatitis C and HIV by sharing syringes and other injection equipment. Over years or decades, a proportion of people with chronic hepatitis C will develop severe liver disease including advanced fibrosis, cirrhosis (scarring), and hepatocellular carcinoma (a form of liver cancer).

Ava John-Baptiste from the University of Toronto and colleagues performed a literature review and meta-analysis to estimate the rate of progression to liver cirrhosis among people infected with HCV through injection drug use.

The investigators searched published literature for articles assessing development of cirrhosis in IDU populations. They collected data on cirrhosis prevalence, proportion of men in the population, average patient age, mean duration of HCV infection, mean alanine aminotransferase (ALT) level, proportion with HIV coinfection, and proportion of heavy alcohol users.


A total of 47 relevant published articles were identified, out of which 44 studies representing a total of 6457 patients were included in the final analysis.
The estimated rate of progression to cirrhosis was 8.1 per 1000 person-years, after adjusting for confounding factors.
This corresponds to a 20-year cirrhosis prevalence of 14.8%.
The rate of liver disease progression was faster in populations that included a higher percentage of men and/or heavy alcohol users.
However, a 5% increase in the proportion of HIV/HCV coinfected people or an ALT increase of 5 IU/L were not associated with faster progression.

These findings led the study authors concluded, "Analysis of aggregate level data suggests that for patients who contracted HCV through injection drug use, prognosis is poor in populations with many male patients and high levels of alcohol consumption."

Investigator affiliations: Department of Health Policy, Management & Evaluation, University of Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Canada; University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.


A John-Baptiste, M Krahn, J Heathcote, and others. The natural history of hepatitis C infection acquired through injection drug use: Meta-analysis and meta-regression. Journal of Hepatology 53(2): 245-51 (Abstract). August 2010.






















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