All-cause and liver-related mortality in hepatitis C infected drug users followed for 33 years: A controlled study

ArticleinJournal of Hepatology 58(1) · September 2012with14 Reads
DOI: 10.1016/j.jhep.2012.08.024 · Source: PubMed
Background & aims: The course of chronic hepatitis C virus (HCV) in injecting drug users (IDUs) has not been well described. The aim of this study was to compare long-term all-cause and liver-related mortality among anti-HCV positive IDUs with and without persisting HCV infection. Methods: A retrospective-prospective controlled cohort design was applied. All IDUs admitted to resident drug treatment (1970-1984) and with available stored sera were screened for anti-HCV antibody. Anti-HCV positive individuals were further tested for the presence of HCV RNA. All-cause and liver-related mortality was compared between HCV RNA positive (n=328) and HCV RNA negative individuals (n=195). The observation was accomplished through register linkage to national registers. Mean observation time was 33 years. Results: All-cause mortality rate was 1.85 (95% CI 1.62-2.11) per 100 person-years, male 2.11 (95% CI 1.84-2.46), female 1.39 (95% CI 1.07-1.79). Mortality rates were not influenced by persisting HCV infection. Main causes of death were intoxications (45.0%), suicide (9.1%), and accidents (8.2%). Liver disease was the cause of death in 7.5% of deaths among HCV RNA positive subjects. Five of 13 deaths among male IDUs with persisting HCV infection occurring after the age of 50 years were caused by liver disease. Conclusions: The all-cause mortality in IDUs is high and with no difference between HCV RNA positive and HCV RNA negative individuals, the first three decades after HCV transmission. However, among IDUs with chronic HCV infection who have survived until 50years of age, HCV infection emerges as the main cause of death.
    • "Hepatitis B and C are frequently mentioned in the literature as diseases related to the use of illegal drugs [11,26], which are even more frequent than HIV [1]. A 33-year retrospective cohort study examined the monitoring of causes of mortality among injectable drug users affected by hepatitis C. The analysis indicated that mortality among drug users is more frequently linked to the use of injectable drugs (intoxication, suicide) than to complications accruing from hepatitis C [11]. Therefore, it is important to diagnose and refer patients to specialized services to initiate the treatment for hepatitis and also to refer the user to a rehabilitation service. "
    [Show abstract] [Hide abstract] ABSTRACT: This study's objective was to analyze the use of illegal drugs by dockworkers and provide risk communication regarding the use of illegal drugs and test for infectious contagious diseases among dockworkers. This cross-sectional study including an intervention addressed to 232 dockworkers, who were individually interviewed, as well as communication of risk with testing for infectious contagious diseases for 93 dockworkers from a city in the interior of Rio Grande do Sul, Brazil. Poisson regression analysis was used. Twenty-nine workers reported the use of illegal drugs. Poisson regression indicated that being a wharfage worker, smoker, having a high income, and heavier workload increases the prevalence of the use of illegal drugs. During risk communication, two workers were diagnosed with hepatitis B (2.2%), three (3.2%) with hepatitis C, two (2.2%) with syphilis. None of the workers, though, had HIV. This study provides evidence that can motivate further research on the topic and also lead to treatment of individuals to improve work safety, productivity, and the health of workers.
    Full-text · Article · Jan 2016
    • "Deaths in prevalent and incident cases: The competitive mortality rate was derived from the French life tables [40]. For active IDU incident cases, an excess mortality rate of 5.27 and 9.74, respectively, for men and women based on a French cohort study [42] , was applied to competitive mortality values to take into account higher mortality than in the general population, due to IDU at-risk behaviors (overdose, suicide, road accidents, etc. [43]). Undiagnosed cases turning 81 between 2004 and 2014 were excluded from the final estimated number since our study population focused on the 18 to 80 year-old population. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Recent HCV therapeutic advances make effective screening crucial for potential HCV eradication. To identify the target population for a possible population-based screening strategy to complement current risk-based testing in France, we aimed to estimate the number of adults with undiagnosed chronic HCV infection and age and gender distribution at two time points: 2004 and 2014. Methods: A model taking into account mortality, HCV incidence and diagnosis rates was applied to the 2004 national seroprevalence survey. Results: In 2014, an estimated 74,102 individuals aged 18 to 80 were undiagnosed for chronic HCV infection (plausible interval: 64,920-83,283) compared with 100,868 [95%CI: 58,534-143,202] in 2004. Men aged 18-59 represented approximately half of the undiagnosed population in 2014. The proportion of undiagnosed individuals in 2004 (43%) varied from 21.9% to 74.1% in the 1945-1965 and 1924-1944 birth cohorts. Consequently, age and gender distributions between the chronically-infected (diagnosed and undiagnosed) and undiagnosed HCV populations were different, the 1945-1965 birth cohort representing 48.9% and 24.7%, respectively. Conclusions: Many individuals were still undiagnosed in 2014 despite a marked reduction with respect to 2004. The present work contributed to the 2014 recommendation of a new French complementary screening strategy, consisting in one-time simultaneous HCV, HBV and HIV testing in men aged 18-60. Further studies are needed to assess the cost-effectiveness and feasibility of such a strategy. We also demonstrated that data on the undiagnosed HCV population are crucial to help adapt testing strategies, as the features of the chronically-infected HCV population are very distinct.
    Full-text · Article · May 2015
    • "Viral hepatitis is common among drug users (DUs), not only those who inject the drug34567, presenting relevant consequences in morbidity and mortality along with high social and economic cost [3,7891011. In DUs deaths from liver disease have increased significantly121314. Chronic carriers have a 25% risk of dying from the consequences of HBV infection, such as cirrhosis and liver cancer [1,2,15]. "
    [Show abstract] [Hide abstract] ABSTRACT: Hepatitis B virus (HBV) hepatitis is extremely common among problematic drug users (DUs). As of 2012, 47 of the 53 European countries had implemented a universal hepatitis B vaccination programme, a scenario that could radically change its spread. Even so, drug users are still one of the main groups at risk of being infected by HBV, exposing the fact that universal vaccination still has not managed to reach an optimal level of contagion protection. In order to evaluate the role of universal HBV vaccination in protecting against risk behaviour related to the use of illicit drugs, a group of 748 DUs, 511 male and 237 female, was tested for HBV markers, at their first access to public addiction clinics in the metropolitan area of Bologna, Italy. 487 were born after 1981, so they were eligible to have received HBV vaccination in adolescence or at birth; in these subjects antibodies against HBV core antigen had the significant prevalence of 6.2%. Universal HBV vaccination has shown evidence of protecting against infection in the general population. These results, amongst the first to evaluate actual protection in DUs vaccinated at birth or during adolescence, show that compulsory universal vaccination does not solve the problem of HBV transmission in the most at risk groups and that additional strategies must be studied and implemented to address this issue.
    Full-text · Article · Apr 2015
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