title: Burden of Liver Disease among Community-Based People Who Inject Drugs (PWID) in Chennai, India.
abstract: OBJECTIVE
  We characterize the burden of liver disease in a cohort of PWID in Chennai, India, with a high prevalence of HCV.
  
  
  METHODS
  1,042 PWID were sampled through community outreach in Chennai. Participants underwent fasting blood draw, questionnaire and an examination that included liver stiffness assessment using transient elastography (Fibroscan) and assessment of steatosis via ultrasound.
  
  
  RESULTS
  The median age was 39 years, all were male, 14.8% were HIV infected and 35.6% were HCV antibody positive, of whom 78.9% were chronically infected (HCV RNA positive). Median liver stiffness was 6.2 kPA; 72.9% had no evidence of or mild stiffness, 14.5% had moderate stiffness, and 12.6% had evidence of severe stiffness/cirrhosis. Prevalence of severe stiffness/cirrhosis was significantly higher among persons who were older, had a longer duration of injecting drugs, higher body mass index, higher prevalence of insulin resistance, higher prevalence of steatosis, higher HCV RNA levels and evidence of alcohol dependence. An estimated 42.1% of severe stiffness/cirrhosis in this sample was attributable to HCV. 529 (53.0%) had some evidence of steatosis. Prevalence of steatosis was higher among those who had larger waist circumference, insulin resistance, higher HDL cholesterol and a history of antiretroviral therapy.
  
  
  CONCLUSIONS
  We observed a high burden of liver disease in this relatively young cohort that was primarily driven by chronic HCV infection, metabolic factors (insulin resistance and steatosis) and heavy alcohol use. Interventions to improve access to HCV treatment and reduce alcohol use are needed to prevent further progression of liver disease.
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: M Suresh
authors.initials: MS
authors.lastname: Kumar
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Saravanan
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Pachamuthu
authors.initials: P
authors.lastname: Balakrishnan
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sulkowski
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000367:Age Factors; D000437:Alcoholism; D000998:Antiviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D055030:Drug Users / Q000706:statistics & numerical data*; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007194:India / Q000453:epidemiology; D007333:Insulin Resistance; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008107:Liver Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014463:Ultrasonography
chemical_list: D000998:Antiviral Agents; D008076:Cholesterol, HDL; D018937:Hepatitis C Antibodies
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