Opioid use and risk of liver fibrosis in <scp>HIV</scp>/hepatitis <scp>C</scp> virus‐coinfected patients in <scp>C</scp>anada

Brunet, Laurence; Moodie, Erica E. M.; Cox, Joseph; Gill, John; Cooper, Curtis; Walmsley, Sharon; Rachlis, Anita; Hull, Mark; Klein, Marina B.

doi:10.1111/hiv.12279

Cited by 8 publications

(16 citation statements)

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“…Half of 73 HIV/HCV co-infected women in the Women’s Interagency HIV Study had significant fibrosis (defined as liver stiffness ≥7.1 kPa by transient elastography) [42] while 24% of 800 HIV/HCV co-infected patients (30% female) enrolled in the Canadian Coinfection Cohort Study had an APRI score ≥1.5 [43], similar to 20% in a cohort of 116 HIV/HCV co-infected patients (36% female) in France, with median age 44 years [44]. Although the HIV/HCV co-infected women here were 13-15 years younger than individuals in these studies, 12% already had significant fibrosis.…”

Section: Discussionmentioning

confidence: 99%

HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study

et al. 2016

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BackgroundUkraine’s injecting drug use-driven HIV epidemic is among the most severe in Europe with high burden of HCV co-infection. HIV/HCV co-infected individuals are at elevated risk of HCV-related morbidity, but little is known about burden of liver disease and associated factors in the HIV-positive population in Ukraine, particularly among women.MethodsCharacteristics of 2050 HIV-positive women enrolled into the Ukrainian Study of HIV-infected Childbearing Women were described by HCV serostatus. Aspartate transaminase (AST) to platelet ratio (APRI) and FIB-4 scores were calculated and exact logistic regression models fitted to investigate factors associated with significant fibrosis (APRI >1.5) among 762 women with an APRI score available.ResultsOf 2050 HIV-positive women (median age 27.7 years, IQR 24.6-31.3), 33% were HCV co-infected (79% of those with a history of injecting drug use vs 23% without) and 17% HBsAg positive. A quarter were on antiretroviral therapy at postnatal cohort enrolment. 1% of the HIV/HCV co-infected group had ever received treatment for HCV. Overall, 24% had an alanine aminotransferase level >41 U/L and 34% an elevated AST (53% and 61% among HIV/HCV co-infected). Prevalence of significant fibrosis was 4.5%; 2.5% among 445 HIV mono-infected and 12.3% among 171 HIV/HCV co-infected women. 1.2% had a FIB-4 score >3.25 indicating advanced fibrosis. HCV RNA testing in a sub-group of 56 HIV/HCV co-infected women indicated a likely spontaneous clearance rate of 18% and predominance of HCV genotype 1, with one-third having genotype 3 infection. Factors associated with significant fibrosis were HCV co-infection (AOR 2.53 95%CI 1.03-6.23), history of injecting drug use (AOR 3.51 95%CI 1.39-8.89), WHO stage 3-4 HIV disease (AOR 3.47 95%CI 1.51-7.99 vs stage 1-2 HIV disease) and not being on combination antiretroviral therapy (AOR 3.08 95%CI 1.23-7.74), adjusted additionally for HBV co-infection, smoking and age.ConclusionsMost HIV/HCV co-infected women had elevated liver enzymes and 12% had significant fibrosis according to APRI. Risk factors for liver fibrosis in this young HIV-positive population include poorly controlled HIV and high burden of HCV. Results highlight the importance of addressing modifiable risk factors and rolling out HCV treatment to improve the health outcomes of this group.

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Section: Discussionmentioning

confidence: 99%

HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study

et al. 2016

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“…Of these, 55 were excluded: 22 studies did not conduct a probabilistic bias analysis; 12 were not pharmacoepidemiologic/comparative effectiveness studies; 8 were reviews, meta‐analyses, or commentaries; seven studies used simulated data only; four were methods papers, one applied probabilistic bias analysis to a causal mediation analysis, and one was a duplicate publication (we kept the earlier of the two publications) . Fifteen were eligible—14 identified through our keyword and citation search and 1 through Google/hand searching …”

Section: Resultsmentioning

confidence: 99%

“…One study simulating outcome misclassification used an external study with a similar patient population for sensitivity/specificity estimates . One study simulating exposure misclassification used validation data from three external studies with different patient populations to define bias parameter distributions . One study used a combination of internal and external validation data to simulate misclassification of a time‐varying exposure (simulating PPV, NPV, and time‐to‐initiation) .…”

Section: Resultsmentioning

confidence: 99%

“…One study provided no details on the bias analysis . Types and ranges of values assigned to probability distributions were discussed in four studies and simulated iterations reported in three—each used ≥1000 iterations …”

Section: Resultsmentioning

confidence: 99%

“…All studies reported adjusting for misclassification at the record‐level; five used the ‘sensmac’ SAS macro . Two studies reported sensitivity analyses and diagnostics .…”

Section: Resultsmentioning

confidence: 99%

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Probabilistic bias analysis in pharmacoepidemiology and comparative effectiveness research: a systematic review

Hunnicutt

Ulbricht

Chrysanthopoulou

et al. 2016

Pharmacoepidemiology and Drug

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Purpose We systematically reviewed pharmacoepidemiologic and comparative effectiveness studies that use probabilistic bias analysis to quantify the effects of systematic error including confounding, misclassification, and selection bias on study results. Methods We found articles published between 2010 and October 2015 through a citation search using Web of Science and Google Scholar and a keyword search using PubMed and Scopus. Eligibility of studies was assessed by one reviewer. Three reviewers independently abstracted data from eligible studies. Results Fifteen studies used probabilistic bias analysis and were eligible for data abstraction – nine simulated an unmeasured confounder and six simulated misclassification. The majority of studies simulating an unmeasured confounder did not specify the range of plausible estimates for the bias parameters. Studies simulating misclassification were in general clearer when reporting the plausible distribution of bias parameters. Regardless of the bias simulated, the probability distributions assigned to bias parameters, number of simulated iterations, sensitivity analyses, and diagnostics were not discussed in the majority of studies. Conclusion Despite the prevalence and concern of bias in pharmacoepidemiologic and comparative effectiveness studies, probabilistic bias analysis to quantitatively model the effect of bias was not widely used. The quality of reporting and use of this technique varied and was often unclear. Further discussion and dissemination of the technique are warranted.

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Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review

et al. 2020

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Purpose of review:We summarize recent literature on the contribution of substance use and depression to non-AIDS-related comorbidities. Discussion of recent randomized clinical trials and implementation research to curtail risk attributed to each behavioral health issue is provided.Recent Findings: Smoking, unhealthy alcohol use, opioid use, and depression are common among PWH and individually contribute to increased risk for non-AIDS-related comorbidities. The concurrence of these conditions is notable, yet understudied, and provides opportunity for linked-screening and potential treatment of more than one behavioral health factor. Current results from randomized clinical trials are inconsistent. Investigating interventions to reduce the impact of these behavioral health conditions with a focus on implementation into clinical care is important.Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. http://www.springer.com/gb/openaccess/authors-rights/aam-terms-v1

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Opioid use and risk of liver fibrosis in HIV/hepatitis C virus‐coinfected patients in Canada

Abstract: Although opioids were commonly used both legally and illegally in our cohort, we were unable to demonstrate a negative impact on liver fibrosis progression.

Cited by 8 publications

References 50 publications

HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study

HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study

Probabilistic bias analysis in pharmacoepidemiology and comparative effectiveness research: a systematic review

Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review

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