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People with diabetes or high alcohol consumption at higher risk of late hepatitis C diagnosis

Keith Alcorn
24 September 2021
Image: Jarun Ontakrai/

People with diabetes and those with hazardous alcohol intake were significantly more likely to remain undiagnosed with hepatitis C and present with advanced fibrosis, a large number of people diagnosed with hepatitis C in France has reported.

The study investigators say that people with diabetes and people with high alcohol intake should be targeted for hepatitis C screening in France, in order to achieve hepatitis C elimination goals by 2030.

The study findings are published in the journal Liver International. Preliminary findings from the study were presented at the International Liver Congress in June.


decompensated cirrhosis

The later stage of cirrhosis, during which the liver cannot perform some vital functions and complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.

Late diagnosis with hepatitis C means that people are likely to have advanced liver fibrosis or may already have cirrhosis. People diagnosed at this stage may be less likely to achieve cure of hepatitis C when treated, and if they have developed decompensated cirrhosis before treatment, they remain at risk of further life-threatening liver events even if they are cured.

Diagnosing hepatitis C before progression to late-stage liver disease is a high priority for preventing liver-related deaths and achieving the hepatitis C elimination targets of diagnosing 90% of people with hepatitis C and reducing liver-related deaths by 65% by 2030.

French researchers investigated factors associated with late diagnosis in people with hepatitis C in the national HEPATHER cohort. They looked for late presentation – people who were found to have cirrhosis or stage 3 or 4 fibrosis less than a year after their first evaluation by a liver specialist (referral for treatment was carried out by liver specialist until 2019 in France).

The HEPATHER cohort consists of 9174 people with hepatitis C recruited since 2012. This analysis was restricted to 1236 people with liver fibrosis data. Around half of the cohort had severe fibrosis or cirrhosis at enrolment in to the cohort.

Multivariable analysis showed that late presentation was associated with male sex, age over 45 years, HCV genotype 3 infection, diabetes, current hazardous alcohol use and current abstinence but past hazardous alcohol use. In this study hazardous alcohol use was defined as two drinks a day in women or three drinks a day in men.

The study investigators say that the association between diabetes and hepatitis C is not unexpected, as hepatitis C can increase the risk of developing diabetes. To reduce the risk of late presentation for hepatitis C treatment, all people with diabetes should be screened for hepatitis C, they recommend. Impaired liver function in people with diabetes should be a warning signal, they say, and requires investigation.

Hazardous alcohol use may speed up the progression of liver disease in people with hepatitis C, the investigators say, explaining its association with late presentation. As well as screening for hepatitis C in people with hazardous alcohol use, doctors should also support engagement in hepatitis C care in people with excessive alcohol use.

Genotype 3 infection is also associated with more rapid progression of liver disease, explaining its association with late presentation, but the investigators say that genotype 3 infection is also a proxy marker for social vulnerability. In France, genotype 3 infection is more common in people who inject drugs, who may be disengaged from health care. Strengthening hepatitis C screening in socially deprived areas and among people who use drugs is likely to reduce late presentation.


Santos M et al. Late presentation for hepatitis C care: time to target people with diabetes and/or hazardous alcohol use (ANRS CO22 HEPATHER cohort). Liver International, published online, 14 September 2021.