Kåberg Martin, Edgren Erika, Hammarberg Anders, Weiland Ola
a Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.
b Stockholm Centre for Dependency Disorders , Stockholm Needle Exchange , Stockholm , Sweden.
Scand J Gastroenterol. 2019 Mar;54(3):319-327. doi: 10.1080/00365521.2019.1580764. Epub 2019 Mar 23.
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. 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. 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. 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.
在注射毒品者（PWID）中共享未消毒的注射设备是丙型肝炎（HCV）的主要传播途径。在斯德哥尔摩针头交换计划（NEP）中，HCV在注射毒品者中高度流行。然而，参与者中晚期肝纤维化的发生率尚不清楚。2016年12月至2018年4月，斯德哥尔摩NEP为所有慢性丙型肝炎感染（CHC）参与者提供了肝纤维化评估，包括肝脏硬度测量（LSM）、病史采集以及扩展血液检测以评估APRI和FIB-4评分。共纳入2037人，其中964人（47.3%）患有CHC。203名（21.1%）符合条件的参与者接受了LSM检测，其中85%有轻度纤维化（LSM≤9.4kPa），15%有晚期纤维化（LSM≥9.5kPa）。APRI>1且FIB-4>3.25仅识别出30%的晚期纤维化参与者。然而，当APRI>1与年龄≥40岁以及注射毒品使用（IDU）时长≥15年相结合时，所有31名（100%）晚期纤维化参与者均被检测出来。我们发现，通过这种易于获得的因素组合可以简化晚期纤维化的诊断检查。这有助于识别需要立即接受HCV治疗以防止疾病进一步进展的注射毒品者。此外，对于年龄<40岁、IDU时长<15年且APRI评分<1所识别出的轻度纤维化注射毒品者，可以避免进行LSM检测。这种策略在LSM不易获得的情况下加强了HCV治疗流程，从而将促进HCV治疗的启动。
