Journal of Gastroenterology and Hepatology
Vincent Wai-Sun Wong1,2, Grace Lai-Hung Wong1,2, Angel Mei-Ling Chim1,2, Tsz-Fai Cheng2, Shirley Wing-Yan Cheung2, Carol Man-Sze Lai2, Kylie Joan-Yi Szeto2, Sharon Tsang2, Stephen Ho-Chun Wu2, Kenneth Kar-Lung Yan3, Alex Yui Hui3, Desmond Chi-Him Yiu3, Brian Bing-Ying Wu3, David Cheung4, Cedric Sze-Lai Chung4, Camey Wai-Man Lai1,2, Henry Lik-Yuen Chan1,2,*
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Abbreviations:HCC, hepatocellular carcinoma; HCV, hepatitis C virus; IDU, injection drug user; IQR, interquartile range; SD, standard deviation
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jgh.12355
Keywords: Liver cirrhosis; interferons; elasticity; opioid-related disorders; patient compliance
Background and Aim
Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community.
Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers.
From 2009 to 2012, we served 234 subjects. 130 (56%) subjects were anti-HCV positive. The number needed to screen to detect 1 patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6-2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA and liver stiffness measurement by transient elastography.
Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.