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Delaying HCV Therapy Among PWID Leads to Advanced Liver Diseases
In a new meta-analysis and systematic review, researchers from New York University found that people who injected drugs who were also positive for hepatitis C virus infection were likely to develop liver problems later in life if left untreated, including cirrhosis and hepatocellular carcinoma, according to published findings in The International Journal of Drug Policy.
“Understanding HCV disease progression rates among people who inject drugs is important to setting policy to expand access to detection, diagnosis and treatment, and in forecasting the burden of disease,” Holly Hagan, PhD, professor at NYU College of Nursing and co-director of the Center for Drug Use and HIV Research (CDUHR), and leader of the HCV Synthesis Project, said in a press release.
Holly Hagan
Hagan and colleagues, including Daniel Smith, MA, assistant research scientist at NYU, analyzed data from 21 published reports that included people who inject drugs (PWID) who also have evidence of chronic HCV. The patients had reported current or previous injection drug use, as well as presented original data on disease progression. All reports included for analysis were published between January 1990 and December 2013, and included data from upper-middle or high-income countries.
“In this study, we synthesized existing data on the natural history of HCV among PWID, including fibrosis progression rates and the incidence of compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma,” Hagan said.
Daniel Smith
The researchers used random-effect models to determine fibrosis progression rate (FPR) and other incidence rates for cirrhosis and HCC. Using a linear estimation model, they found the “pooled stage-constant” FPR was 0.117 units per year (95% CI, 0.099–0.135). This sequence determined the average time to cirrhosis was 34 years and time to stage F3 fibrosis was 26 years post-infection.
The Markov maximum likelihood estimation method was used to determine stage-specific incident rates to determine progression. The FPR for stage F0 to F1 was 0.128 (95% CI 0.08, 0.176); 0.059 (95% CI 0.035, 0.082) for F1 to F2; 0.078 (95% CI 0.056, 0.1) for F2 to F3; and 0.116 (95% CI 0.07, 0.161) for F3 to F4. This sequence determined the average time to compensated cirrhosis was 46 years and time to stage F3 fibrosis was 38 years post-infection.
The pooled incidence rate for compensated cirrhosis was 6.6 events per 1,000 person-years (95% CI 4.8-8.4), 1.1 events per 1,000 person-years for decompensated cirrhosis (95% CI 0.8-1.4), and 0.3 events per 1,000 person-years for HCC (95% CI, – 0.1-0.6).
According to the release, the researchers believe that treating HCV early will benefit PWID due to the fact that new HCV treatments include shorter drug regimens. These, however, are expensive, and eligibility guidelines may exclude patients from getting the proper treatment.
“These limitations may delay treatment for years and, thus, will disproportionately affect PWID and other low-income patients,” Hagan said in the release. “These restrictions also are in conflict with new HCV treatment guidelines from the American Association for the Study of Liver Disease, which explicitly state that active injection drug users should be prioritized for treatment in part because of the risk of transmission to susceptible injection partners.”
The researchers concluded: “Left untreated, PWID with chronic HCV infection will develop liver sequelae in mid to late adulthood. … Scaling up of effective HCV prevention and early engagement in care and treatment will facilitate the elimination [of] HCV as a source of serious disease in PWID.” – by Melinda Stevens
Disclosures: The researchers report no relevant financial disclosures.