van Santen Daniëla K, Schim van der Loeff Maarten F, Cartier van Dissel Judith, Martens Jonie P D, van der Valk Marc, Prins Maria
Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam.
Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (AMC).
Eur J Gastroenterol Hepatol. 2018 Oct;30(10):1168-1176. doi: 10.1097/MEG.0000000000001213.
The incidence and prevalence of hepatitis C virus (HCV) infection among people who use drugs (PWUD) peaked in the 1980s in Amsterdam. As liver cirrhosis develops several decades after HCV infection and PWUD have other risk factors for liver fibrosis, we hypothesized that significant liver fibrosis or cirrhosis is now common among PWUD in Amsterdam.
PWUD were recruited from the Amsterdam Cohort Studies, methadone programmes and addiction clinics during 2009-2016. Transient elastography was performed to assess liver stiffness. We estimated METAVIR fibrosis levels on the basis of the following liver stiffness measurements (LSMs) cut-offs: F0-F2 (no/mild) less than 7.65 kPa; F2-F3 (moderate/severe) at least 7.65 to less than 13 kPa; and F4 (cirrhosis) at least 13 kPa. Using linear regression models, we assessed the association between LSM and sociodemographic, clinical and behavioural determinants in (a) all PWUD and (b) chronic hepatitis C virus (cHCV)-infected PWUD.
For 140 PWUD, the median LSM was 7.6 kPa (interquartile range=4.9-12.0); 26.4% had moderate/severe fibrosis and 22.9% had cirrhosis. Of 104 chronically infected PWUD, 57.7% had evidence of significant fibrosis (≥F2). In multivariable analysis including all PWUD, increased LSM was associated significantly with cHCV monoinfection and HIV/HCV coinfection. In cHCV-infected PWUD, older age was associated significantly with increased LSM. In all groups, longer duration of heavy alcohol drinking was associated with increased LSM.
A high proportion of PWUD had significant fibrosis or cirrhosis that were associated with cHCV infection, HIV/HCV coinfection and duration of heavy alcohol drinking. Increased uptake of HCV treatment and interventions to reduce alcohol use are needed to decrease the liver disease burden in this population.
20世纪80年代，阿姆斯特丹吸毒者中丙型肝炎病毒（HCV）感染的发病率和患病率达到峰值。由于HCV感染后数十年才会发展为肝硬化，且吸毒者还有其他导致肝纤维化的风险因素，我们推测阿姆斯特丹的吸毒者中现在显著肝纤维化或肝硬化很常见。
2009年至2016年期间，从阿姆斯特丹队列研究、美沙酮项目和成瘾诊所招募吸毒者。进行瞬时弹性成像以评估肝脏硬度。我们根据以下肝脏硬度测量（LSM）临界值估计METAVIR纤维化水平：F0 - F2（无/轻度）小于7.65kPa；F2 - F3（中度/重度）至少7.65至小于13kPa；F4（肝硬化）至少13kPa。使用线性回归模型，我们评估了（a）所有吸毒者以及（b）慢性丙型肝炎病毒（cHCV）感染的吸毒者中LSM与社会人口统计学、临床和行为决定因素之间的关联。
对于140名吸毒者，LSM中位数为7.6kPa（四分位间距 = 4.9 - 12.0）；26.4%有中度/重度纤维化，22.9%有肝硬化。在104名慢性感染的吸毒者中，57.7%有显著纤维化（≥F2）的证据。在包括所有吸毒者的多变量分析中，LSM升高与cHCV单一感染和HIV/HCV合并感染显著相关。在cHCV感染的吸毒者中，年龄较大与LSM升高显著相关。在所有组中，长期大量饮酒时间较长与LSM升高相关。
很大一部分吸毒者有显著纤维化或肝硬化，这与cHCV感染、HIV/HCV合并感染以及长期大量饮酒时间有关。需要增加HCV治疗的接受度并采取减少酒精使用的干预措施，以减轻该人群的肝脏疾病负担。
