TY - JOUR
T1 - Severity and correlates of liver disease in hepatitis C virus-infected injection drug users
AU - Rai, Rudra
AU - Wilson, Lucy E.
AU - Astemborski, Jacquie
AU - Anania, Frank
AU - Torbenson, Michael
AU - Spoler, Charles
AU - Vlahov, David
AU - Strathdee, Steffanie A.
AU - Boitnott, John
AU - Nelson, Kenrad E.
AU - Thomas, David L.
N1 - Funding Information:
Abbreviations: HCV, hepatitis C virus; IDUs, injection drug users; ESLD, end stage liver disease; ALT, alanine transaminase; HIV, human immunodeficiency virus; total MHAI, Ishak total modified histologic activity index; AST, aspartate transaminase; GGT, gamma glutamyl transpeptidase. From the 1Divisions of Gastroenterology and 2Infectious Diseases, and the 3Department of Pathology, The Johns Hopkins School of Medicine; the 4Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD; and the5New York Academy of Medicine, New York, NY. Received November 14, 2001; accepted February 22, 2002. Supported by National Institutes of Health grants RO1 DA04334, RO1 DA12568, M01 RR00052, and R01 DA10627. Address reprint requests to: David L. Thomas, M.D., M.P.H., The Johns Hopkins University School of Medicine, Division of Infectious Diseases, 424 N. Bond St., Baltimore, MD 21231-1001. E-mail: dthomas@jhmi.edu; fax: 410-614-7564. Copyright © 2002 by the American Association for the Study of Liver Diseases. 0270-9139/02/3505-0028$35.00/0 doi:10.1053/jhep.2002.33151
PY - 2002
Y1 - 2002
N2 - Between May 1996 and June 1998, 210 members of a cohort of 1, 667 hepatitis C virus (HCV)-infected injection drug users (IDUs) were selected for liver biopsy procedure after stratification based on 2 consecutive serum alanine transaminase (ALT) levels. Liver histology, which could be fully evaluated for 207 subjects, was classified by using the modified Ishak scores. At the time of biopsy, the median age of subjects was 41.3 years and the median estimated duration of HCV infection was 20.7 years; 94% were African American; 78% men; 31% were human immunodeficiency virus (HIV) seropositive; and 76% had HCV genotype la or lb. Total modified histologic activity index (MHAI) scores ranged from 0 to 9, and 26.6% had a total MHAI score of 5 or greater. Persons with a total MHAI score of 5 or greater were more likely to be HIV infected (P = .04). Higher fibrosis, indicated by Ishak modified fibrosis scores of 3 to 6, was present in 10.1% of subjects and was found more often in those older than 46 years of age (the highest quartile) (P < .01). Both fibrosis scores of 3 or greater and total scores of 5 or greater were associated with elevated ALT, aspartate transaminase (AST), and γ-glutamyl transpeptidase (GGT) levels (P < .01). When serial values were considered, the results of liver enzyme testing could reduce the probability of an IDU having a fibrosis score of 3 or greater from 10% to 3%. In conclusion, these data indicate that severe liver disease is uncommon in this urban, HCV-infected IDU cohort, especially in younger persons and those with repeatedly normal liver enzymes.
AB - Between May 1996 and June 1998, 210 members of a cohort of 1, 667 hepatitis C virus (HCV)-infected injection drug users (IDUs) were selected for liver biopsy procedure after stratification based on 2 consecutive serum alanine transaminase (ALT) levels. Liver histology, which could be fully evaluated for 207 subjects, was classified by using the modified Ishak scores. At the time of biopsy, the median age of subjects was 41.3 years and the median estimated duration of HCV infection was 20.7 years; 94% were African American; 78% men; 31% were human immunodeficiency virus (HIV) seropositive; and 76% had HCV genotype la or lb. Total modified histologic activity index (MHAI) scores ranged from 0 to 9, and 26.6% had a total MHAI score of 5 or greater. Persons with a total MHAI score of 5 or greater were more likely to be HIV infected (P = .04). Higher fibrosis, indicated by Ishak modified fibrosis scores of 3 to 6, was present in 10.1% of subjects and was found more often in those older than 46 years of age (the highest quartile) (P < .01). Both fibrosis scores of 3 or greater and total scores of 5 or greater were associated with elevated ALT, aspartate transaminase (AST), and γ-glutamyl transpeptidase (GGT) levels (P < .01). When serial values were considered, the results of liver enzyme testing could reduce the probability of an IDU having a fibrosis score of 3 or greater from 10% to 3%. In conclusion, these data indicate that severe liver disease is uncommon in this urban, HCV-infected IDU cohort, especially in younger persons and those with repeatedly normal liver enzymes.
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U2 - 10.1053/jhep.2002.33151
DO - 10.1053/jhep.2002.33151
M3 - Article
C2 - 11981775
AN - SCOPUS:18344386203
SN - 0270-9139
VL - 35
SP - 1247
EP - 1255
JO - Hepatology
JF - Hepatology
IS - 5
ER -