Estimating past hepatitis C infection risk from reported risk factor histories

Implications for imputing age of infection and modeling fibrosis progression

Peter Bacchetti, Phyllis C. Tien, Eric Carl Seaberg, Thomas R. O'Brien, Michael H. Augenbraun, Alex H. Kral, Michael P. Busch, Brian R. Edlin

Research output: Contribution to journalArticle

Abstract

Background: Chronic hepatitis C virus infection is prevalent and often causes hepatic fibrosis, which can progress to cirrhosis and cause liver cancer or liver failure. Study of fibrosis progression often relies on imputing the time of infection, often as the reported age of first injection drug use. We sought to examine the accuracy of such imputation and implications for modeling factors that influence progression rates. Methods: We analyzed cross-sectional data on hepatitis C antibody status and reported risk factor histories from two large studies, the Women's Interagency HIV Study and the Urban Health Study, using modern survival analysis methods for current status data to model past infection risk year by year. We compared fitted distributions of past infection risk to reported age of first injection drug use. Results: Although injection drug use appeared to be a very strong risk factor, models for both studies showed that many subjects had considerable probability of having been infected substantially before or after their reported age of first injection drug use. Persons reporting younger age of first injection drug use were more likely to have been infected after, and persons reporting older age of first injection drug use were more likely to have been infected before. Conclusion: In cross-sectional studies of fibrosis progression where date of HCV infection is estimated from risk factor histories, modern methods such as multiple imputation should be used to account for the substantial uncertainty about when infection occurred. The models presented here can provide the inputs needed by such methods. Using reported age of first injection drug use as the time of infection in studies of fibrosis progression is likely to produce a spuriously strong association of younger age of infection with slower rate of progression.

Original languageEnglish (US)
Article number145
JournalBMC Infectious Diseases
Volume7
DOIs
StatePublished - Dec 10 2007

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Hepatitis C
Fibrosis
Injections
Infection
Pharmaceutical Preparations
Age Factors
Liver Neoplasms
Urban Health
Modern 1601-history
Hepatitis C Antibodies
Liver Failure
Chronic Hepatitis C
Virus Diseases
Survival Analysis
Hepacivirus
Uncertainty
Cross-Sectional Studies
HIV
Liver

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Estimating past hepatitis C infection risk from reported risk factor histories : Implications for imputing age of infection and modeling fibrosis progression. / Bacchetti, Peter; Tien, Phyllis C.; Seaberg, Eric Carl; O'Brien, Thomas R.; Augenbraun, Michael H.; Kral, Alex H.; Busch, Michael P.; Edlin, Brian R.

In: BMC Infectious Diseases, Vol. 7, 145, 10.12.2007.

Research output: Contribution to journalArticle

Bacchetti, Peter ; Tien, Phyllis C. ; Seaberg, Eric Carl ; O'Brien, Thomas R. ; Augenbraun, Michael H. ; Kral, Alex H. ; Busch, Michael P. ; Edlin, Brian R. / Estimating past hepatitis C infection risk from reported risk factor histories : Implications for imputing age of infection and modeling fibrosis progression. In: BMC Infectious Diseases. 2007 ; Vol. 7.
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