title: Chronic hepatitis C in Swedish subjects receiving opiate substitution therapy--factors associated with advanced fibrosis.
abstract: BACKGROUND
  Opiate substitution therapy (OST) reduces the risk of death from directly drug-related causes in heroin users, allowing other chronic health problems to emerge. People who inject drugs (PWID) are exposed to hepatitis C virus (HCV), with an associated risk of chronic liver disease. We investigated HCV prevalence and liver-related morbidity in a cohort of OST recipients, and analyzed factors associated with significant hepatic fibrosis.
  
  
  METHODS
  All patients registered on 1 April 2008 in 4 clinics providing OST in the 3 largest cities in Sweden were eligible for inclusion. HCV viremic subjects were evaluated for fibrosis stage by liver biopsy, transient elastometry (TE), and/or a biochemical fibrosis index (Göteborg University Cirrhosis Index; GUCI). Factors associated with severity of fibrosis were determined by logistic regression analysis.
  
  
  RESULTS
  Out of 524 eligible patients, 277 consented to enrolment. Two hundred and thirty-six subjects (88%) were anti-HCV-positive, and 162 of these were viremic (69%). Significant liver fibrosis (defined as Ishak stages F3-F6, TE value ≥ 8.85 kPa, or GUCI > 0.33) was found in 69 out of 103 (67%) tested viremic patients, and was associated with alcohol intake (p = 0.03), higher body mass index (BMI; p = 0.04), and the presence of anti-HBc antibodies (indicating exposure to hepatitis B virus (HBV); p = 0.02).
  
  
  CONCLUSIONS
  Significant liver fibrosis was detected in two-thirds of HCV viremic OST recipients in this cohort, and was associated with alcohol use, high BMI, and exposure to HBV. These findings indicate that the management of HCV and associated risk factors should be emphasized in Swedish OST programs.
authors.affiliation: From the Department of Clinical Sciences, Section for Infectious Diseases, Lund University , Malmö
authors.forename: Anna
authors.initials: A
authors.lastname: Jerkeman
authors.forename: Johan
authors.initials: J
authors.lastname: Westin
authors.forename: Martin
authors.initials: M
authors.lastname: Lagging
authors.forename: Gunnar
authors.initials: G
authors.lastname: Norkrans
authors.forename: Christer
authors.initials: C
authors.lastname: Lidman
authors.forename: Jan
authors.initials: J
authors.lastname: Frimand
authors.forename: Christian
authors.initials: C
authors.lastname: Simonsberg
authors.forename: Johan
authors.initials: J
authors.lastname: Kakko
authors.forename: Anders
authors.initials: A
authors.lastname: Widell
authors.forename: Per
authors.initials: P
authors.lastname: Björkman
mesh_terms: D000328:Adult; D005260:Female; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult