The natural history of hepatitis C infection acquired through injection drug use: Meta-analysis and meta-regression

John-Baptiste, Ava; Krahn, Murray; Heathcote, Jenny; Laporte, Audery; Tomlinson, George

doi:10.1016/j.jhep.2010.03.015

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Volume 53, Issue 2 , Pages 245-251, August 2010

The natural history of hepatitis C infection acquired through injection drug use: Meta-analysis and meta-regression

Ava John-Baptiste
- Department of Health Policy, Management & Evaluation, University of Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Canada
- University Health Network, Toronto, Canada
- Corresponding author at: Toronto Health Economics & Technology Assessment (THETA) Collaborative, University of Toronto, 144 College Street, 6th Floor, Room 658, Toronto, Canada M5S 3M2. Tel.: +1 416 946 3718; fax: +1 416 946 3719.
Murray Krahn
- Department of Health Policy, Management & Evaluation, University of Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Canada
- Faculty of Pharmacy, University of Toronto, Canada
- University Health Network, Toronto, Canada
Jenny Heathcote
- University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
Audery Laporte
- Department of Health Policy, Management & Evaluation, University of Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
George Tomlinson
- Department of Health Policy, Management & Evaluation, University of Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
- University Health Network, Toronto, Canada

Received 14 December 2009; received in revised form 16 February 2010; accepted 9 March 2010. published online 11 May 2010.

Background & Aims

Our aim was to estimate the rate of progression to cirrhosis for those infected with hepatitis C virus (HCV) through injection drug use.

Methods

We searched the published literature for articles assessing cirrhosis in this population and abstracted data on cirrhosis prevalence, mean duration of infection, mean age, mean alanine aminotransferase (ALT) enzyme levels, proportion of males, proportion HIV co-infected, proportion consuming excessive alcohol, and study setting. Summary progression rates were estimated using weighted averages and random effects Poisson meta-regression. The impact of co-variates was assessed by estimating the posterior probability that the relative risk (RR) of progression exceeded 1.0.

Results

A total of 47 published articles were identified. After adjusting for covariates in 44 studies representing 6457 patients, the estimated rate of progression to cirrhosis, was 8.1 per 1000 person-years (95% credible region (CR), 3.9–14.7). This corresponds to a 20-year cirrhosis prevalence of 14.8% (95% CR, 7.5–25.5). A 5% increase in the proportion of male participants and a 5% increase in the proportion consuming excessive alcohol were associated with faster progression (probability RR>1=0.97 and 0.92, respectively). A 5% increase in the proportion of HIV co-infected, an increase in ALT of 5IU/L and studies in settings with a high risk of referral bias were not associated with faster progression (probability RR>1=0.42, 0.65, and 0.43, respectively).

Conclusions

Analysis of aggregate level data suggests that for patients who contracted HCV through injection drug use prognosis is poor in populations with many male patients and high levels of alcohol consumption.

Abbreviations: IDU, injection drug user, HCV, hepatitis C virus, ALT, alanine aminotransferase, HCC, hepatocellular carcinoma, HIV, human immunodeficiency virus