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
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.