Prevalence and Determinants of Liver Disease among People who use Drugs in Amsterdam, The Netherlands

Author: Daniela K. van Santen, Judith Cartier van Dissel, Jannie van der Helm, Jonie Martens, Marc van der Valk, Maarten Schim van der Loeff, Maria Prins

Theme: Epidemiology & Public Health Research Year: 2016


Daniela K. van Santen1, Judith Cartier van Dissel1, Jannie van der Helm1, Jonie Martens1, Marc van der Valk2, Maarten Schim van der Loeff1,3, Maria Prins1,3

1. Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, the Netherlands

2. HIV and AIDS department, Academic Medical Center, Amsterdam, the Netherlands

3. Department of Infectious Diseases, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, the Netherlands

Background: In Amsterdam, Hepatitis C virus (HCV) incidence peaked in 1980s, when >85% of people who use drugs (PWUD) tested anti-HCV positive. As chronic HCV infection may lead to severe liver fibrosis and cirrhosis 20-30 years after infection, we hypothesized that HCV-related disease is now common among PWUD in Amsterdam. We aimed to assess the prevalence and determinants of liver disease among PWUD from the Amsterdam Cohort Study (ACS).

Methods: Transient elastography (FibroScan) was used to determine liver stiffness presence (<7.65 Metavir:F0-F2 (no/mild); >=7.65-<13 Metavir:F2-F3/4 (moderate); >=13 Metavir:F4 (cirrhosis). PWUD were examined in two waves. First, in 2011-2012, we included HCV-RNA+ PWUD from the ACS and PWUD referred from addiction care to the HCV-outpatient clinic linked to the ACS. During the second wave, 2015-2016, we included ACS participants, irrespective of HCV status. We assessed the association between moderate/severe liver stiffness and duration of excessive alcohol use (>=5 glasses/day), HIV status, HCV status (HCV-antibodies and RNA positivity) and duration, current BMI, duration of drug use, sex, age and ethnicity using multinominal logistic regression.

Results: Among 127 PWUD, median liver stiffness was 6.7 kPA (Interquartile-range: 4.5-11.9); 26% had evidence of moderate and 24% had severe liver stiffness. Prevalence of cirrhosis was higher among PWUD included during the first wave (29%, 29/99) than PWUD from the second wave (7%, 2/28, of whom 48% was HCV negative). Being HCV-positive and longer HCV-infection duration were significantly associated in univariable analysis with liver stiffness. In multivariable analysis among HCV-positive PWUD only, longer duration of excessive alcohol use (>=3 years) was significantly associated severe liver stiffness/cirrhosis (AORmoderate=0.9;95%CI=0.2-3.6; aORcirrhosis=5.4;95%CI=1.3-22.0), while duration of HCV infection was not (p=0.16).

Conclusion: We found a high prevalence of liver disease, especially among HCV-positive PWUD. Increased HCV-treatment uptake and interventions to reduce alcohol use are needed to reduce the risk of liver disease among PWUD in Amsterdam.

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