The Impact Of High Risk Behaviors And Hepatitis C On Mortality In Drug Users. A Register Based Cohort Study On 5350 Persons Connected To Drug Use Treatment 1996-2014.

Author: Øvrehus, A, Nielsen, S, Hansen JF, Holm, DK, Christensen, PB

Theme: Epidemiology & Public Health Research Year: 2018

Hepatitis C (HCV) is prevalent among persons with current or former drug use (PWUD) and
mainly among persons who inject drugs (PWID). The impact of chronic hepatitis C(CHC) on
mortality in PWUD and PWID is difficult to elucidate due to the high mortality and competing
risks of death.
Register based cohort study on persons enrolled in drug treatment services in Funen
region(500.000 inhabitants) between 1996-2014 using the National Danish register for drug
use treatment(SIB). From SIB history of drug and alcohol use and opioid substitution
therapy(OST) was derived. Having ever injected or been on OST was classified as high risk
drug use. HCV status(tested, exposed, chronic) was derived from the regional laboratory
database. Cause and date of death from the Danish Death Certificate register and classified
as liver related, un-natural or other causes. Standardized mortality ratios(SMR) were
calculated using sex, age and year of death matched mortality rates(MR) from the Danish
National statistics bureau.
The cohort comprised 5350 persons (75% male) followed for 49403 person years(PY).
There were 571 deaths (11% liver-related, 68% non-natural). In total 2698 had high risk drug
use (68% OST, 89%PWID). The SMR was 8.7/5.0 for high risk/low risk users with crude
MR(cMR) 1.6 pr. 100/PY and 0.4 pr. 100/PY respectively(cMR ratio 3.6(2.8-4.6) p<0.01). In high/low risk users test-uptake was 77%/30%, 63%/4% was exposed and 37.5%/1.9% had CHC. In tested PWID adjusting for sex, age, history of OST and age at entry in SIB, adjusted hazard ratio(aHR) for death in HCV-RNA+ as compared to exposed was 1.2(1.0- 1.6) p=0.17. For liver related death adjusting for alcohol aHR was 1.4(0.7-2.8) p=0.33. Conclusion: We found a high mortality among PWUD compared to the general population but no significant difference between being HCV exposed and having CHC on overall or liver related mortality in PWID. Disclosure of Interest Statement: Anne Øvrehus has received research grants from the Gilead Nordic Fellowship for this and other projects. Gilead Sciences has not been involved in the design, data analysis or presentation of this data. Anne Øvrehus has received travels support, speaker and consultancy fees from Abbvie, Merck, Gilead and BMS. Peer Christensen has recieved travel support and research grants from Abbvie, Merck, Gilead and BMS. Dorte Holm, Stine Nielsen and Janne Hansen has nothing to disclose

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