Current prevalence of and risk factors for liver cirrhosis in opioid agonist therapy patients of the SAMMSU cohort after 5 years of unrestricted DAA access.


Author: Andrea Bregenzer, Philip Bruggmann, Erika Castro, Pascale Della Santa, Katharina Hensel-Koch, Alberto Moriggia, Christine Thurnheer, Claude Scheidegger

Theme: Epidemiology & Public Health Research Year: 2023

Background:
Direct-acting antivirals (DAAs), with chronic hepatitis C cure rates of nearly 100%, are reimbursed without liver fibrosis restriction in Switzerland since 2017. With 84% HCV-treatment-uptake, HCV-RNA-prevalence among HCV-antibody-positives has decreased to 12% in the Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort. Thus, prevalence of and risk factors for liver cirrhosis should be reassessed.

Methods:
Between 2014 and 02/03/2023, 1346 >18-year-old opioid agonist therapy (OAT) patients were recruited: 62% HCV-antibody-positive, 10% HIV-antibody-positive (thereof 96% HCV-co-infected). 15% had alcohol overconsumption (≥49g/d) and 20% obesity (BMI>30kg/m2) in at least one follow-up. Liver cirrhosis (F4) was defined as Fibroscan® >12.5kPa at the last available examination.

Results:
In 68% (914/1346), Fibroscan® results were available: in 82% (683/828) of HCV-antibody-positive and in 45% (231/518) of HCV-antibody-negative patients. Prevalence of HIV-infection and alcohol overconsumption (≥49g/d) was significantly higher among HCV-antibody-positive patients (15% versus 1%, and 18% versus 11%, respectively), with no difference regarding obesity (BMI>30kg/m2) (21% versus 19%).
Overall, 12.9% (118/914) had liver cirrhosis (F4, >12.5kPa) in their last Fibroscan® (HCV-antibody-positive: 16.1% (110/683), HCV-antibody-negative: 3.5% (8/231), OR: 5.4, p<0.001). Cirrhosis prevalence was similar for HIV/HCV-co- and HCV-mono-infected patients (17.6% (19/108) versus 15.8% (91/575), p=0.647). Obesity (BMI>30kg/m2) and alcohol (≥49g/d) were risk factors for liver cirrhosis (23.9% versus 10.2%, OR 2.8, p<0.001, and 25.8% versus 10.4%, OR 3.0, p<0.001). Among obese HCV-antibody-positive patients consuming alcohol ≥49g/d, liver cirrhosis prevalence was highest (33.3%) (Figure 1).

Conclusion:
In the era of universal antiretroviral therapy and almost 100% HCV cure rates irrespective of HIV-status, HIV-co-infection may no longer be an independent risk factor for liver cirrhosis among HCV-antibody-positive OAT-patients. Since alcohol overconsumption and obesity are associated with increased liver cirrhosis prevalence, both in HCV-antibody-positive and HCV-antibody-negative patients, and highly prevalent among OAT-patients, a universal liver fibrosis screening should be considered in the aging population of OAT-patients.

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