Theme: Clinical Research Year: 2019
Background: Assessment of liver damage is relevant for prioritizing HCV treatment. Most
persons who inject drugs (PWID) became HCV-infected at younger ages and duration of
infection correlates with progression of liver disease. We aimed to analyze stages of liver
fibrosis among the HCV-positive, non-treated patients in an opioid substitution therapy (OST)
program in metropolitan Barcelona, Spain.
Methods: cross-sectional study in those visited in a municipal OST program between 10/2015
and 9/2017. Socio-demographics, substance use characteristics, HCV and HIV status, and
laboratory parameters were analyzed during the study period. Medical records were used to
ascertain liver fibrosis and history of HCV treatment before and after the introduction of
direct-acting antivirals (DAAs) in Spain. Advanced Liver Fibrosis (ALF) was defined when FIB-4
>3.25 and APRI >1.5.
Results: 501 patients (81.4% M), median age of 45 years (interquartile range [IQR]: 39–50
years). Overall prevalence of anti-HCV was 67% (336/501) and life-time prevalence of HCV
treatment among the eligible was 41.3% (128/310); 26/336 anti-HCV patients cleared the
infection.
182/310 anti-HCV positive patients were treatment-naïve and 43% (78/182) of them had HIV
co-infection. Prevalence of ALF by FIB-4 and APRI was 19.6% and 15%, respectively.
Only 20% (38/182) of HCV-treatment naïve patients underwent Transient Elastography
(median liver stiffness 6.6 kPa (IQR: 5.5–11.6 kPa) and 39/182 (21%) had no clinical records
regarding the assessment of liver disease.
HCV/HIV co-infected patients never treated against HCV had higher prevalence of ALF than the
HCV-monoinfected (24% vs. 7% by FIB-4 (p=0.010); 29% vs. 11% by APRI, (p=0.008)).
Conclusion: almost two thirds of the HCV-positive patients in this OST program are treatmentnaïve. Among the HCV/HIV co-infected patients never treated against HCV one in fourth may
have advanced fibrosis of the liver.
Disclosure of interest: The authors have no conflicts of interest relevant to this article to
disclose. Work partially funded by Gilead Fellowship Program, Gilead Sciences [grant
GLD17/187]