Theme: Epidemiology & Public Health Research Year: 2019
Background: Chronic infection with hepatitis B and C virus (HBV and HCV) can progress to liver
cirrhosis and lead to decompensated liver disease, hepatocellular carcinoma and liver-related
death. Antiviral agents against HBV are very effective in suppressing viremia and direct acting
antivirals (DAAs) for HCV have sustained virologic response rates of >95% and greatly reduce
the risk of complications if treatment is initiated before the onset of advanced liver disease
(ALD). The aim of this study is to assess the prevalence of late presentation in PWID in Spain.
Methods: We conducted a retrospective cohort study through clinical history revision of
patients seeking first time care with a liver specialist at nine tertiary Spanish hospitals with
available 2018 data. Late presentation includes ALD defined by significant fibrosis (≥F3
assessed by either APRI score >1.5, FIB-4 >3.2, transient elastography (FibroScan) >9.5 kPa or
biopsy ≥ METAVIR stage F3) with no previous antiviral treatment. Prevalence of ALD at first
consultation, mode of transmission and risk factors were analysed.
Results: 1,115 patients chronically infected were identified; 217 with HBV and 898 with HCV.
ALD was detected in 14.7% (n=32) of HBV cases and in 25.3% (n=227) for HCV. Injecting drug
use was the most frequent mode of transmission of HCV infection (25.9%; n=233) and 9.8%
(89) cases reported an unknown mode of transmission. 77.1% (n=168) of HBV cases had an
unknown mode of transmission and 0 reported cases due to injecting drug use. Overall,
24.9% of PWID presented late for HCV care.
Conclusion: Late presentation with HBV and HCV is common in Spain despite unrestricted
access to antiviral therapy. To improve outcomes and reach the elimination goal adopted by
WHO, strategies addressing PWID are essential. The large amount of unknown modes of
transmission could contribute to an underestimation of the real number of PWID presenting
late with viral hepatitis.
Conflict of Interest statements: CP, ER, and AG have no conflicts of interest to report. MB
reports advisory board and speaker fees from Gilead Sciences, Merck, and Abbvie. SL reports
advisor and speaker fees from Abbvie, Gilead Sciences, Janssen and MSD. JA reports speaker
fees from Gilead Sciences and MSD. JT has no conflicts of interest to report pertaining to the
submitted work. JGS has no conflicts of interest to report pertaining to the submitted work.
JC reports speaker and board fees from Gilead Sciences, Abbvie, MSD, Celgene and is a
board member of Intercept Pharmaceuticals. MAS reports consulting and conference fees
from Gilead Sciences, Abbvie, and MSD and clinical trial funding from Gilead Sciences and
Abbvie. JLC reports speaker and consultant fees from Gilead Sciences, Abbvie, MSD. JVL
reports grants, personal fees and non-financial support from Abbvie, Gilead Sciences, MSD,
and personal fees from Janssen and Cepheid, all outside the submitted work.