Theme: Epidemiology & Public Health Research Year: 2016
HIGH PREVALENCE OF LIVER FIBROSIS AMONG PEOPLE ATTENDING ADDICTION CLINICS AND REHABILITATION FACILITIES IN SOUTHERN SWITZERLAND: RESULTS OF TWO DIFFERENT SCREENING PROGRAMS FOR LIVER DISEASE
Alberto Moriggia1,2, Lorenzo Magenta1, Benedetta Terziroli1, Vanina Gurtner1, Elena Fossati1, Markus Weimann2, Andreas Cerny1
1Epatocentro Ticino Liver Clinic, Lugano, Switzerland, 2Ingrado Servizi per le Dipendenze, Lugano, Switzerland
Background: People who use drugs (PWUD) are at higher risk of suffering from liver disease compared to the general population. Unfortunately, the rate of liver disease diagnosis, workup and treatment is low in this population. Early identification of people with liver fibrosis together with a proper diagnostic workup and treatment prevent the progression to cirrhosis and its complications.
Methods: Two screening campaigns were conducted in institutions committed to rehabilitation of substance users in Canton Ticino, southern Switzerland. The first program, conducted in 2011, consisted in an educational session followed by a transient elastography (TE) and ALT (alanine aminotransferase) testing offered free of charge to concerned subjects. The second survey was performed in 2013-2014, with a free of charge TE measurement offered directly to all subjects in their facilities.
Results: Pooling the results together, 11 institutions committed to the rehabilitation of substance users in Canton Ticino were globally involved in the two surveys, 7 of them offering residential and 4 of them offering daytime rehabilitation and opiate substitution programs. A total of 199 subjects underwent TE testing, of whom 154 (77%) had a valid and reliable measurement. Globally, 74 subjects (48%) had abnormal values (Stiffness > 6.0 kPa) and 22 (14%) had values compatible with advanced fibrosis/liver cirrhosis (Stiffness > 12.5 kPa).
Discussion: The results of our analysis point out a very high burden of liver disease among PWUD in southern Switzerland. Almost half of the subjects who were screened successfully had liver stiffness values requiring at least a second step of investigation to exclude the presence of some risk factor for liver disease. About 1 out of 7 participants in both screenings had results compatible with advanced fibrosis/cirrhosis, requiring some deeper diagnostic workup to better define liver disease, etiology and possible therapy needed.
Sponsoring: The study was supported by Infodrog (on behalf of Swiss Federal Office of Public Health), by the Ticino Cantonal Officer of Health, by Roche Pharma, Merck Sharp & Dohme, Gilead Sciences and Novartis Pharma.
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