43 Serial transient elastography readings indicate progression of untreated fibrosis among patients attending opioid substitution treatment clinic in south county dublin

Abstract

Background Injecting drug use (IDU) is a major driver of the hepatitis c virus (HCV) epidemic. Opioid substitution treatment clinics (OST) are the main provider of care for these individuals. Aim To assess the prevalence of significant liver disease and progression in patients attending an OST clinic and evaluate the effectiveness of opportunistic Transient Elastography (TE) service in this setting. Method Unselected serial TE readings were carried out on patients in the OST clinic in 2008 and 2016. Mortality in the 2008 group was related to TE readings and progression of TE readings from 2008 to 2016 was recorded. Results In 2008, 84 patients were scanned. Of these 77% were HCV Ab positive and 58% of this group were HCV viraemic. By 2016, all of the 2008 patients with TE scores>13 Kilopascal (Kpa) had died (a total of 13 patients) and 11 of these patients died as a result of liver failure associated with hepatitis c viraemia and alcohol. In 2016 105 scans were carried out on surviving patients from 2008 who still attended the clinic and on new patients attending the clinic. 16 patients (15%) of the 2016 population had TE scores>13 Kpa, the previous threshold for death at eight years. Conclusions This longitudinal data demonstrates universal mortality at 8 years among OST patients with a TE reading of 13 Kpa or greater. Among surviving patients it demonstrated widespread progression of TE readings to levels indicating a requirement for early DAA treatment, and to levels previously associated with high mortality.