Burden of Liver Disease among Community-Based People Who Inject Drugs (PWID) in Chennai, India.

Sunil S Solomon,Allison M Mcfall,Suniti Solomon,Shanmugam Saravanan,Pachamuthu Balakrishnan,David L Thomas,M Suresh Kumar,Shruti H Mehta,Mark S Sulkowski,Aylur K Srikrishnan,Anand S Mehta

doi:10.1371/journal.pone.0147879

Abstract

Background and ObjectiveWe characterize the burden of liver disease in a cohort of PWID in Chennai, India, with a high prevalence of HCV.Materials and Methods1,042 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.ResultsThe 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.ConclusionsWe 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.

Highlights

In high-income countries, mortality due to liver disease has eclipsed HIV-associated mortality [1]
We observed a high burden of liver disease in this relatively young cohort that was primarily driven by chronic HCV infection, metabolic factors and heavy alcohol use
In this relatively young population of PWID with a high prevalence of chronic HCV, we identified a high burden of liver disease

Summary

Introduction

In high-income countries, mortality due to liver disease has eclipsed HIV-associated mortality [1]. As access to antiretroviral therapy (ART) for HIV continues to improve globally, a similar pattern will follow in low-and-middle-income settings (LMICs) where an estimated 90% of the 185 million HCV-infected persons reside [2]. There are limited epidemiologic data on the burden of HCV and associated liver disease in LMICs [4]. These settings have a different background of comorbidities, co-infections and environmental characteristics, which may accelerate liver fibrosis progression and/or complicate treatment. We characterize the burden of liver disease in a cohort of PWID in Chennai, India, with a high prevalence of HCV

Objectives

Results

Conclusion