BACKGROUND AND OBJECTIVES: HCV infection often remains untreated in people who inject drugs (PWID), albeit they may present with advanced liver fibrosis at a young age. We aimed to assess the rate of patients with significant fibrosis in PWID starting anti-HCV therapy and identify the factors associated with severe fibrosis. METHODS: The cohort of 200 patients was divided into two groups: F0-F2 (N = 154, 77%), patients with liver stiffness measurement (LSM) < 10.0 kPa, and F3-F4 (N = 46, 23%), with LSM ≥ 10.0 kPa, indicating significant liver fibrosis. RESULTS: In group F3-F4, there were significantly more males, and the patients were older, with a higher BMI. The number of long-term abstaining patients was significantly higher in group F3-F4 compared with group F0-F2, as well as the proportion of patients reporting harmful drinking. Obesity (OR 4.77), long-term abstinence from illicit drugs (OR 4.06), harmful drinking (OR 2.83), and older age (OR 1.17) were significant predictors of advanced fibrosis in PWID starting anti-HCV therapy. CONCLUSIONS: A quarter of PWID presented with significant liver fibrosis at treatment initiation. Obesity, long-term drug abstinence, harmful drinking, and older age contributed to significant liver fibrosis.

1st Faculty of Medicine Charles University 12108 Prague Czech Republic

3rd Faculty of Medicine Charles University 10034 Prague Czech Republic

Cardiothoracic Anaesthesiology and Intensive Care Department of Anaesthesiology and Intensive Care Medicine Institute for Clinical and Experimental Medicine 14021 Prague Czech Republic

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine 14021 Prague Czech Republic

Department of Internal Medicine University Hospital Kralovske Vinohrady 10034 Prague Czech Republic

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