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High prevalence of chronic hepatitis C in injecting drug users in Tanzania, East Africa: a neglected burden of disease
POSTER PRESENTATIONS assumed to have a poor prognosis with a significant risk of dying within one year. WHO performance scores are significantly worse in patients with cirrhosis meeting EOLC. Assessment of EOLC and implementation of end of life care are likely to have a major impact on the quality of life of patients with cirrhosis.
Institute, Paris, France; 5Infectious Diseases, Royal Free Hospital, London, United Kingdom; 6Virology, Hopital Henry Mondor, Université Paris-Est, Paris, France; 7Haematology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania, United Republic of E-mail: [email protected]
FRI-482 High levels of transmission of HCV infection among people who inject drugs in Greece V. Sypsa1, P. Vickerman2, L. Wiessing3, M. Malliori4, A. Hatzakis1. 1 Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece; 2School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; 3 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; 4Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece E-mail: [email protected]
Background and Aims: The World Health Organisation (WHO) has recently called for hepatitis C virus (HCV) elimination and has identified injecting drug users (IDUs) as a key population. In subSaharan Africa, especially in East Africa, the use of injectable drugs is an emerging issue and data on chronic HCV in IDUs is missing. This study aimed to assess the prevalence and severity of chronic hepatitis C among IDUs enrolled in an opioid substitution treatment (OST) programme in Dar-es-Salaam, Tanzania. Methods: Between May and July 2015, consecutive patients with HCV seropositive results, enrolled in the local OST centre, were invited to participate in the study. All had an epidemiological questionnaire and were offered liver assessment including fasting liver stiffness measurement (LSM) using Fibroscan, abdominal ultrasound, liver function tests, HCV RNA detection (CAP/CTM HCV version 2.0, Roche Molecular Systems, Pleasanton, CA) and genotyping (NS5B gene phylogenetic analysis) if viral load detectable. Results: When the study commenced 1,011 IDUs were registered in the local Methadone clinic. Out of them 731 (72%) were tested for HCV serology. Of these 388 (53%) had a positive result. However 235 (61%) were not recruited in the study because of death, loss of followup or refusal. Therefore 153 patients with a positive HCV serology were assessed: 141 (92%) were male, median age 38 (IQR 34–41). 41 patients (27%) had a significant history of excess alcohol intake (≥50 g per day). The median time since the first injection of drug was 22 years (IQR 18–26). Of the 153 patients, 65 (44%) were HIV co-infected, 15 (10%) also had a positive HBs antigen, 116 (76%) had a detectable HCV RNA, median HCV RNA 5.7 (IQR 4–6.3) Log IU/mL. Only genotypes 1a (68%) and 4a (32%) were identified. The median LSM was 5.3 kPa (IQR 4.4–6.5) and 21 (17%) had clinically significant fibrosis (≥F2), 6 (5%) were considered cirrhotic (F4). None of these patients had access to HCV antiviral therapy. Conclusions: Although the use of injectable drugs in East Africa is a poorly covered topic, there is clearly a significant burden of chronic hepatitis C, with many having HIV and HBV co-infections. Screening, access to care and treatment for HCV in IDUs in Africa should be urgently improved in order to comply with the HCV elimination goal.
Background and Aims: One of the WHO targets for eliminating HCV infection is reducing the number of new chronic cases by 90% by 2030. In Greece, people who inject drugs (PWID) constitute the key population driving the epidemic. The aim of this analysis is to assess HCV transmission among PWID injecting for up to 2 years (new injectors) and identify associated risk factors in order to tailor appropriate interventions. Methods: A seek-test-treat intervention was implemented in 2012– 2013 during an HIV outbreak among PWID in Athens (ARISTOTLE programme). Five rounds of respondent driven sampling were used to recruit PWID. New injectors were also tested for anti-HCV. HCV incidence was estimated: (i) using data from all new injectors, assuming they were seronegative when they started injecting and that infection occurred in the midpoint between the initiation of injecting and the time of blood sample collection, (ii) using data from new injectors withmultiple participationswhoseroconvertedduringthe programme. Multiple logistic regression was used to identify characteristics associated with prevalent anti-HCV status at first participation. Results: Among 431 new injectors, anti-HCV prevalence at first participation was 49.9% [95% CI: 45.0%, 54.7%]. The corresponding HCV incidence was estimated at 51.1/100 person-years [95% CI: 44.7– 58.4]. Out of 63 anti-HCV negative new injectors with multiple blood samples, 16 seroconverted during the programme. HCV incidence based on seroconverters was 56.3/100 person-years [95% CI: 34.5, 91.8]. Predictors of anti-HCV status at first participation (adjusted Odds Ratios [95% Confidence Intervals]) were injecting at least once/ day vs. less than once/week: 5.00 [3.04, 8.21], using cocaine as main substance of injection vs. heroin: 4.48 [2.34–8.56], female gender vs. male: 1.96 [1.10–3.50] and history of imprisonment vs. without: 1.58 [0.99–2.52]. At first participation, 5.8% of new injectors reported being on opioid substitution treatment and 21.7% had received as many or more syringes in the past month as their number of injections. Of those found anti-HCV positive at first participation, one third (35.6%) were aware of their serostatus and 0.9% reported having received treatment for HCV. Conclusions: The incidence of HCV infection is high in the population of new injectors in Athens. It is unlikely that Greece will be able to reach the WHO target of reducing new infections unless highcoverage harm reduction programmes are combined with increased access to HCV treatment. FRI-483 High prevalence of chronic hepatitis C in injecting drug users in Tanzania, East Africa: a neglected burden of disease Z. Mohamed1, J. Mbwambo2, J. Rwegasha3, Y. Shimakawa4, S. Bhagani5, S. Chevaliez6, J. Makani7, S. Taylor-Robinson1, M. Thursz1, M. Lemoine1. 1Hepatology, Imperial College London, London, United Kingdom; 2Psychiatry, Muhimbili University of Health and Allied Sciences; 3Gastroenterology, Muhimbili National Hospital, Dar-es-Salaam, Tanzania, United Republic of; 4Epidemiology, Pasteur S416
Fatty liver disease: Clinical aspects FRI-319 Long-term disease progression in chronic hepatitis B Chinese patients with comorbid nonalcoholic fatty liver disease J.G. Fan1, G.F. Chen2,3, D. Ji2,3,4, D.W. Ye5, C. Wang3,6,7, Q. Shao2,3, F. Li2,3, B. Li2,3, V. Wu3,6, A. Wong6, Y.D. Wang3,6, J. Chen3,6, A. Sanyal8, G. Lau3,6,9 and on behalf of The Greater China Fatty Liver Consortium. 1 Department of Gastroenterology, Xinhua Hospital, Shanghai; 2Second Liver Cirrhosis Diagnosis and Treatment Center; 3Beijing 302-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre; 4Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China; 5State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong; 6Division of Gastroenterology & Hepatology, Humanity & Health Medical Centre, Hong Kong, Hong Kong, China; 7 State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; 8Physiology and Molecular Pathology, Virginia Commonwealth University, School of Medicine, Richmond, United States; 9Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China E-mail: [email protected]
Journal of Hepatology 2017 vol. 66 | S333–S542
Institute, Paris, France; 5Infectious Diseases, Royal Free Hospital, London, United Kingdom; 6Virology, Hopital Henry Mondor, Université Paris-Est, Paris, France; 7Haematology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania, United Republic of E-mail: [email protected]
FRI-482 High levels of transmission of HCV infection among people who inject drugs in Greece V. Sypsa1, P. Vickerman2, L. Wiessing3, M. Malliori4, A. Hatzakis1. 1 Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece; 2School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; 3 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; 4Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece E-mail: [email protected]
Background and Aims: The World Health Organisation (WHO) has recently called for hepatitis C virus (HCV) elimination and has identified injecting drug users (IDUs) as a key population. In subSaharan Africa, especially in East Africa, the use of injectable drugs is an emerging issue and data on chronic HCV in IDUs is missing. This study aimed to assess the prevalence and severity of chronic hepatitis C among IDUs enrolled in an opioid substitution treatment (OST) programme in Dar-es-Salaam, Tanzania. Methods: Between May and July 2015, consecutive patients with HCV seropositive results, enrolled in the local OST centre, were invited to participate in the study. All had an epidemiological questionnaire and were offered liver assessment including fasting liver stiffness measurement (LSM) using Fibroscan, abdominal ultrasound, liver function tests, HCV RNA detection (CAP/CTM HCV version 2.0, Roche Molecular Systems, Pleasanton, CA) and genotyping (NS5B gene phylogenetic analysis) if viral load detectable. Results: When the study commenced 1,011 IDUs were registered in the local Methadone clinic. Out of them 731 (72%) were tested for HCV serology. Of these 388 (53%) had a positive result. However 235 (61%) were not recruited in the study because of death, loss of followup or refusal. Therefore 153 patients with a positive HCV serology were assessed: 141 (92%) were male, median age 38 (IQR 34–41). 41 patients (27%) had a significant history of excess alcohol intake (≥50 g per day). The median time since the first injection of drug was 22 years (IQR 18–26). Of the 153 patients, 65 (44%) were HIV co-infected, 15 (10%) also had a positive HBs antigen, 116 (76%) had a detectable HCV RNA, median HCV RNA 5.7 (IQR 4–6.3) Log IU/mL. Only genotypes 1a (68%) and 4a (32%) were identified. The median LSM was 5.3 kPa (IQR 4.4–6.5) and 21 (17%) had clinically significant fibrosis (≥F2), 6 (5%) were considered cirrhotic (F4). None of these patients had access to HCV antiviral therapy. Conclusions: Although the use of injectable drugs in East Africa is a poorly covered topic, there is clearly a significant burden of chronic hepatitis C, with many having HIV and HBV co-infections. Screening, access to care and treatment for HCV in IDUs in Africa should be urgently improved in order to comply with the HCV elimination goal.
Background and Aims: One of the WHO targets for eliminating HCV infection is reducing the number of new chronic cases by 90% by 2030. In Greece, people who inject drugs (PWID) constitute the key population driving the epidemic. The aim of this analysis is to assess HCV transmission among PWID injecting for up to 2 years (new injectors) and identify associated risk factors in order to tailor appropriate interventions. Methods: A seek-test-treat intervention was implemented in 2012– 2013 during an HIV outbreak among PWID in Athens (ARISTOTLE programme). Five rounds of respondent driven sampling were used to recruit PWID. New injectors were also tested for anti-HCV. HCV incidence was estimated: (i) using data from all new injectors, assuming they were seronegative when they started injecting and that infection occurred in the midpoint between the initiation of injecting and the time of blood sample collection, (ii) using data from new injectors withmultiple participationswhoseroconvertedduringthe programme. Multiple logistic regression was used to identify characteristics associated with prevalent anti-HCV status at first participation. Results: Among 431 new injectors, anti-HCV prevalence at first participation was 49.9% [95% CI: 45.0%, 54.7%]. The corresponding HCV incidence was estimated at 51.1/100 person-years [95% CI: 44.7– 58.4]. Out of 63 anti-HCV negative new injectors with multiple blood samples, 16 seroconverted during the programme. HCV incidence based on seroconverters was 56.3/100 person-years [95% CI: 34.5, 91.8]. Predictors of anti-HCV status at first participation (adjusted Odds Ratios [95% Confidence Intervals]) were injecting at least once/ day vs. less than once/week: 5.00 [3.04, 8.21], using cocaine as main substance of injection vs. heroin: 4.48 [2.34–8.56], female gender vs. male: 1.96 [1.10–3.50] and history of imprisonment vs. without: 1.58 [0.99–2.52]. At first participation, 5.8% of new injectors reported being on opioid substitution treatment and 21.7% had received as many or more syringes in the past month as their number of injections. Of those found anti-HCV positive at first participation, one third (35.6%) were aware of their serostatus and 0.9% reported having received treatment for HCV. Conclusions: The incidence of HCV infection is high in the population of new injectors in Athens. It is unlikely that Greece will be able to reach the WHO target of reducing new infections unless highcoverage harm reduction programmes are combined with increased access to HCV treatment. FRI-483 High prevalence of chronic hepatitis C in injecting drug users in Tanzania, East Africa: a neglected burden of disease Z. Mohamed1, J. Mbwambo2, J. Rwegasha3, Y. Shimakawa4, S. Bhagani5, S. Chevaliez6, J. Makani7, S. Taylor-Robinson1, M. Thursz1, M. Lemoine1. 1Hepatology, Imperial College London, London, United Kingdom; 2Psychiatry, Muhimbili University of Health and Allied Sciences; 3Gastroenterology, Muhimbili National Hospital, Dar-es-Salaam, Tanzania, United Republic of; 4Epidemiology, Pasteur S416
Fatty liver disease: Clinical aspects FRI-319 Long-term disease progression in chronic hepatitis B Chinese patients with comorbid nonalcoholic fatty liver disease J.G. Fan1, G.F. Chen2,3, D. Ji2,3,4, D.W. Ye5, C. Wang3,6,7, Q. Shao2,3, F. Li2,3, B. Li2,3, V. Wu3,6, A. Wong6, Y.D. Wang3,6, J. Chen3,6, A. Sanyal8, G. Lau3,6,9 and on behalf of The Greater China Fatty Liver Consortium. 1 Department of Gastroenterology, Xinhua Hospital, Shanghai; 2Second Liver Cirrhosis Diagnosis and Treatment Center; 3Beijing 302-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre; 4Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China; 5State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong; 6Division of Gastroenterology & Hepatology, Humanity & Health Medical Centre, Hong Kong, Hong Kong, China; 7 State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; 8Physiology and Molecular Pathology, Virginia Commonwealth University, School of Medicine, Richmond, United States; 9Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China E-mail: [email protected]
Journal of Hepatology 2017 vol. 66 | S333–S542