Factors associated with liver fibrosis in intravenous drug users coinfected with HIV and HCV

Reliable non-invasive methods for the evaluation of liver fibrosis are desirable, and the risk factors associated with fibrosis are not fully identified. A cross-sectional study of a cohort of 805 HIV-HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug use...

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Veröffentlicht in:Antiviral therapy 2011, Vol.16 (1), p.27-35
Hauptverfasser: CARTON, José A, COLLAZOS, Julio, DE LA FUENTE, Belén, LUISA GARCIA-ALCALDE, Maria, SUAREZ-ZARRACINA, Tomas, RODRIGUEZ-GUARDADO, Azucena, ASENSI, Victor
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container_end_page 35
container_issue 1
container_start_page 27
container_title Antiviral therapy
container_volume 16
creator CARTON, José A
COLLAZOS, Julio
DE LA FUENTE, Belén
LUISA GARCIA-ALCALDE, Maria
SUAREZ-ZARRACINA, Tomas
RODRIGUEZ-GUARDADO, Azucena
ASENSI, Victor
description Reliable non-invasive methods for the evaluation of liver fibrosis are desirable, and the risk factors associated with fibrosis are not fully identified. A cross-sectional study of a cohort of 805 HIV-HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug users, was conducted. Liver fibrosis was measured by transient elastometry with cutoff values of 7.2 kPa (significant fibrosis), 9.4 kPa (advanced fibrosis) and 14.0 kPa (cirrhosis), and by liver fibrosis indexes (LFI; APRI, Forns and FIB-4). Available liver biopsies were also evaluated. The prevalences of significant fibrosis, advanced fibrosis and cirrhosis were 55.8%, 38.4% and 23.5%, respectively. A number of parameters were associated both in the univariate and multivariate analyses with each of the diverse fibrosis groups; however, only six of them were predictive of all stages of fibrosis: heavy alcohol intake (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.02-5.59; P < 0.001), duration of HCV infection (OR 1.13, 95% CI 1.07-1.19; P < 0.001), CDC category C3 (OR 1.80, 95% CI 1.07-3.02; P=0.026), anti-HCV treatment failure (OR 4.37, 95% CI 2.24-8.55; P < 0.001), thrombocytopaenia (OR 1.015, 95% CI 1.011-1.019; P < 0.001) and increased aspartate aminotransferase (1.006, 95% CI 1.0021-1.010; P = 0.004). Furthermore, 53%, 68% and 80% of patients with significant fibrosis, advanced fibrosis and cirrhosis, respectively, had increased measures on at least one of the LFI, with the Forns index being the most sensitive. Area under the receiver operating characteristic curves of elastometry to predict histological fibrosis was 0.83 (95% CI 0.76-0.90), 0.89 (95% CI 0.83-0.95) and 0.87 (95% CI 0.80-0.94) for Metavir score ≥ F2, ≥ F3 and F4, respectively. Elastometry constitutes a useful tool in the diagnosis and follow-up of HIV-HCV-coinfected patients. Fibrosis is associated with diverse factors, some of them treatable or preventable, which need to be addressed considering the high prevalence and course of fibrosis in these patients.
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A cross-sectional study of a cohort of 805 HIV-HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug users, was conducted. Liver fibrosis was measured by transient elastometry with cutoff values of 7.2 kPa (significant fibrosis), 9.4 kPa (advanced fibrosis) and 14.0 kPa (cirrhosis), and by liver fibrosis indexes (LFI; APRI, Forns and FIB-4). Available liver biopsies were also evaluated. The prevalences of significant fibrosis, advanced fibrosis and cirrhosis were 55.8%, 38.4% and 23.5%, respectively. A number of parameters were associated both in the univariate and multivariate analyses with each of the diverse fibrosis groups; however, only six of them were predictive of all stages of fibrosis: heavy alcohol intake (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.02-5.59; P &lt; 0.001), duration of HCV infection (OR 1.13, 95% CI 1.07-1.19; P &lt; 0.001), CDC category C3 (OR 1.80, 95% CI 1.07-3.02; P=0.026), anti-HCV treatment failure (OR 4.37, 95% CI 2.24-8.55; P &lt; 0.001), thrombocytopaenia (OR 1.015, 95% CI 1.011-1.019; P &lt; 0.001) and increased aspartate aminotransferase (1.006, 95% CI 1.0021-1.010; P = 0.004). Furthermore, 53%, 68% and 80% of patients with significant fibrosis, advanced fibrosis and cirrhosis, respectively, had increased measures on at least one of the LFI, with the Forns index being the most sensitive. Area under the receiver operating characteristic curves of elastometry to predict histological fibrosis was 0.83 (95% CI 0.76-0.90), 0.89 (95% CI 0.83-0.95) and 0.87 (95% CI 0.80-0.94) for Metavir score ≥ F2, ≥ F3 and F4, respectively. Elastometry constitutes a useful tool in the diagnosis and follow-up of HIV-HCV-coinfected patients. Fibrosis is associated with diverse factors, some of them treatable or preventable, which need to be addressed considering the high prevalence and course of fibrosis in these patients.</description><identifier>ISSN: 1359-6535</identifier><identifier>EISSN: 2040-2058</identifier><identifier>DOI: 10.3851/IMP1708</identifier><identifier>PMID: 21311106</identifier><language>eng</language><publisher>London: International Medical Press</publisher><subject>Addictive behaviors ; Adult ; Adult and adolescent clinical studies ; Alcoholism - complications ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiviral agents ; Antiviral Agents - administration &amp; dosage ; Antiviral Agents - adverse effects ; Area Under Curve ; Aspartate Aminotransferases - analysis ; Biological and medical sciences ; Cohort Studies ; Cross-Sectional Studies ; Drug addiction ; Drug Users ; Female ; Fibrosis - diagnosis ; Fibrosis - epidemiology ; Fibrosis - etiology ; Fibrosis - pathology ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepacivirus ; Hepatitis C virus ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - drug therapy ; Hepatitis C, Chronic - pathology ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - pathology ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Infectious diseases ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - epidemiology ; Liver Cirrhosis - etiology ; Liver Cirrhosis - pathology ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Pharmacology. Drug treatments ; Prevalence ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Risk Factors ; Severity of Illness Index ; Substance Abuse, Intravenous - complications ; Thrombocytopenia - complications ; Treatment Failure ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>Antiviral therapy, 2011, Vol.16 (1), p.27-35</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c342t-875428657231aa1c88f9b19a47660cc752f7401d276c4b91adcd4ea2eea754783</citedby><cites>FETCH-LOGICAL-c342t-875428657231aa1c88f9b19a47660cc752f7401d276c4b91adcd4ea2eea754783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,4012,27910,27911,27912</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=23948225$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21311106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CARTON, José A</creatorcontrib><creatorcontrib>COLLAZOS, Julio</creatorcontrib><creatorcontrib>DE LA FUENTE, Belén</creatorcontrib><creatorcontrib>LUISA GARCIA-ALCALDE, Maria</creatorcontrib><creatorcontrib>SUAREZ-ZARRACINA, Tomas</creatorcontrib><creatorcontrib>RODRIGUEZ-GUARDADO, Azucena</creatorcontrib><creatorcontrib>ASENSI, Victor</creatorcontrib><title>Factors associated with liver fibrosis in intravenous drug users coinfected with HIV and HCV</title><title>Antiviral therapy</title><addtitle>Antivir Ther</addtitle><description>Reliable non-invasive methods for the evaluation of liver fibrosis are desirable, and the risk factors associated with fibrosis are not fully identified. A cross-sectional study of a cohort of 805 HIV-HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug users, was conducted. Liver fibrosis was measured by transient elastometry with cutoff values of 7.2 kPa (significant fibrosis), 9.4 kPa (advanced fibrosis) and 14.0 kPa (cirrhosis), and by liver fibrosis indexes (LFI; APRI, Forns and FIB-4). Available liver biopsies were also evaluated. The prevalences of significant fibrosis, advanced fibrosis and cirrhosis were 55.8%, 38.4% and 23.5%, respectively. A number of parameters were associated both in the univariate and multivariate analyses with each of the diverse fibrosis groups; however, only six of them were predictive of all stages of fibrosis: heavy alcohol intake (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.02-5.59; P &lt; 0.001), duration of HCV infection (OR 1.13, 95% CI 1.07-1.19; P &lt; 0.001), CDC category C3 (OR 1.80, 95% CI 1.07-3.02; P=0.026), anti-HCV treatment failure (OR 4.37, 95% CI 2.24-8.55; P &lt; 0.001), thrombocytopaenia (OR 1.015, 95% CI 1.011-1.019; P &lt; 0.001) and increased aspartate aminotransferase (1.006, 95% CI 1.0021-1.010; P = 0.004). Furthermore, 53%, 68% and 80% of patients with significant fibrosis, advanced fibrosis and cirrhosis, respectively, had increased measures on at least one of the LFI, with the Forns index being the most sensitive. Area under the receiver operating characteristic curves of elastometry to predict histological fibrosis was 0.83 (95% CI 0.76-0.90), 0.89 (95% CI 0.83-0.95) and 0.87 (95% CI 0.80-0.94) for Metavir score ≥ F2, ≥ F3 and F4, respectively. Elastometry constitutes a useful tool in the diagnosis and follow-up of HIV-HCV-coinfected patients. Fibrosis is associated with diverse factors, some of them treatable or preventable, which need to be addressed considering the high prevalence and course of fibrosis in these patients.</description><subject>Addictive behaviors</subject><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Alcoholism - complications</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - administration &amp; dosage</subject><subject>Antiviral Agents - adverse effects</subject><subject>Area Under Curve</subject><subject>Aspartate Aminotransferases - analysis</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Cross-Sectional Studies</subject><subject>Drug addiction</subject><subject>Drug Users</subject><subject>Female</subject><subject>Fibrosis - diagnosis</subject><subject>Fibrosis - epidemiology</subject><subject>Fibrosis - etiology</subject><subject>Fibrosis - pathology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepacivirus</subject><subject>Hepatitis C virus</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Hepatitis C, Chronic - pathology</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - pathology</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - epidemiology</subject><subject>Liver Cirrhosis - etiology</subject><subject>Liver Cirrhosis - pathology</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Pharmacology. Drug treatments</subject><subject>Prevalence</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Substance Abuse, Intravenous - complications</subject><subject>Thrombocytopenia - complications</subject><subject>Treatment Failure</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>1359-6535</issn><issn>2040-2058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1Lw0AQhhdRbK3iP5C9iKfozn4km6MUawsVPWhPQphsNrqSJnU3qfjvjRjrVRiYy_O-MzyEnAK7FFrB1eLuARKm98iYM8kizpTeJ2MQKo1iJdSIHIXwxhjXKWOHZMRBAACLx-R5hqZtfKAYQmMctragH659pZXbWk9Ll_smuEBd3U_rcWvrpgu08N0L7YLtg6ZxdWnNLjhfrCjWBZ1PV8fkoMQq2JNhT8jT7OZxOo-W97eL6fUyMkLyNtKJklzHKuECEMFoXaY5pCiTOGbGJIqXiWRQ8CQ2Mk8BC1NIi9xa7JOJFhNy8dO78c17Z0ObrV0wtqqwtv23mVZacuAa_kFCf1Vx-UeaXkDwtsw23q3Rf2bAsm_n2eC8J8-Gzi5f22LH_UrugfMBwGCwKj3WxoU_TqRSc67EF5h9h18</recordid><startdate>2011</startdate><enddate>2011</enddate><creator>CARTON, José A</creator><creator>COLLAZOS, Julio</creator><creator>DE LA FUENTE, Belén</creator><creator>LUISA GARCIA-ALCALDE, Maria</creator><creator>SUAREZ-ZARRACINA, Tomas</creator><creator>RODRIGUEZ-GUARDADO, Azucena</creator><creator>ASENSI, Victor</creator><general>International Medical Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7U9</scope><scope>H94</scope></search><sort><creationdate>2011</creationdate><title>Factors associated with liver fibrosis in intravenous drug users coinfected with HIV and HCV</title><author>CARTON, José A ; COLLAZOS, Julio ; DE LA FUENTE, Belén ; LUISA GARCIA-ALCALDE, Maria ; SUAREZ-ZARRACINA, Tomas ; RODRIGUEZ-GUARDADO, Azucena ; ASENSI, Victor</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c342t-875428657231aa1c88f9b19a47660cc752f7401d276c4b91adcd4ea2eea754783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Addictive behaviors</topic><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Alcoholism - complications</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - administration &amp; dosage</topic><topic>Antiviral Agents - adverse effects</topic><topic>Area Under Curve</topic><topic>Aspartate Aminotransferases - analysis</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Cross-Sectional Studies</topic><topic>Drug addiction</topic><topic>Drug Users</topic><topic>Female</topic><topic>Fibrosis - diagnosis</topic><topic>Fibrosis - epidemiology</topic><topic>Fibrosis - etiology</topic><topic>Fibrosis - pathology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepacivirus</topic><topic>Hepatitis C virus</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - drug therapy</topic><topic>Hepatitis C, Chronic - pathology</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - pathology</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - epidemiology</topic><topic>Liver Cirrhosis - etiology</topic><topic>Liver Cirrhosis - pathology</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Pharmacology. Drug treatments</topic><topic>Prevalence</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Substance Abuse, Intravenous - complications</topic><topic>Thrombocytopenia - complications</topic><topic>Treatment Failure</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CARTON, José A</creatorcontrib><creatorcontrib>COLLAZOS, Julio</creatorcontrib><creatorcontrib>DE LA FUENTE, Belén</creatorcontrib><creatorcontrib>LUISA GARCIA-ALCALDE, Maria</creatorcontrib><creatorcontrib>SUAREZ-ZARRACINA, Tomas</creatorcontrib><creatorcontrib>RODRIGUEZ-GUARDADO, Azucena</creatorcontrib><creatorcontrib>ASENSI, Victor</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Antiviral therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CARTON, José A</au><au>COLLAZOS, Julio</au><au>DE LA FUENTE, Belén</au><au>LUISA GARCIA-ALCALDE, Maria</au><au>SUAREZ-ZARRACINA, Tomas</au><au>RODRIGUEZ-GUARDADO, Azucena</au><au>ASENSI, Victor</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with liver fibrosis in intravenous drug users coinfected with HIV and HCV</atitle><jtitle>Antiviral therapy</jtitle><addtitle>Antivir Ther</addtitle><date>2011</date><risdate>2011</risdate><volume>16</volume><issue>1</issue><spage>27</spage><epage>35</epage><pages>27-35</pages><issn>1359-6535</issn><eissn>2040-2058</eissn><abstract>Reliable non-invasive methods for the evaluation of liver fibrosis are desirable, and the risk factors associated with fibrosis are not fully identified. A cross-sectional study of a cohort of 805 HIV-HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug users, was conducted. Liver fibrosis was measured by transient elastometry with cutoff values of 7.2 kPa (significant fibrosis), 9.4 kPa (advanced fibrosis) and 14.0 kPa (cirrhosis), and by liver fibrosis indexes (LFI; APRI, Forns and FIB-4). Available liver biopsies were also evaluated. The prevalences of significant fibrosis, advanced fibrosis and cirrhosis were 55.8%, 38.4% and 23.5%, respectively. A number of parameters were associated both in the univariate and multivariate analyses with each of the diverse fibrosis groups; however, only six of them were predictive of all stages of fibrosis: heavy alcohol intake (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.02-5.59; P &lt; 0.001), duration of HCV infection (OR 1.13, 95% CI 1.07-1.19; P &lt; 0.001), CDC category C3 (OR 1.80, 95% CI 1.07-3.02; P=0.026), anti-HCV treatment failure (OR 4.37, 95% CI 2.24-8.55; P &lt; 0.001), thrombocytopaenia (OR 1.015, 95% CI 1.011-1.019; P &lt; 0.001) and increased aspartate aminotransferase (1.006, 95% CI 1.0021-1.010; P = 0.004). Furthermore, 53%, 68% and 80% of patients with significant fibrosis, advanced fibrosis and cirrhosis, respectively, had increased measures on at least one of the LFI, with the Forns index being the most sensitive. Area under the receiver operating characteristic curves of elastometry to predict histological fibrosis was 0.83 (95% CI 0.76-0.90), 0.89 (95% CI 0.83-0.95) and 0.87 (95% CI 0.80-0.94) for Metavir score ≥ F2, ≥ F3 and F4, respectively. Elastometry constitutes a useful tool in the diagnosis and follow-up of HIV-HCV-coinfected patients. Fibrosis is associated with diverse factors, some of them treatable or preventable, which need to be addressed considering the high prevalence and course of fibrosis in these patients.</abstract><cop>London</cop><pub>International Medical Press</pub><pmid>21311106</pmid><doi>10.3851/IMP1708</doi><tpages>9</tpages></addata></record>
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subjects Addictive behaviors
Adult
Adult and adolescent clinical studies
Alcoholism - complications
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiviral agents
Antiviral Agents - administration & dosage
Antiviral Agents - adverse effects
Area Under Curve
Aspartate Aminotransferases - analysis
Biological and medical sciences
Cohort Studies
Cross-Sectional Studies
Drug addiction
Drug Users
Female
Fibrosis - diagnosis
Fibrosis - epidemiology
Fibrosis - etiology
Fibrosis - pathology
Gastroenterology. Liver. Pancreas. Abdomen
Hepacivirus
Hepatitis C virus
Hepatitis C, Chronic - complications
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - pathology
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - pathology
Human immunodeficiency virus
Human viral diseases
Humans
Infectious diseases
Liver Cirrhosis - diagnosis
Liver Cirrhosis - epidemiology
Liver Cirrhosis - etiology
Liver Cirrhosis - pathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Pharmacology. Drug treatments
Prevalence
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Risk Factors
Severity of Illness Index
Substance Abuse, Intravenous - complications
Thrombocytopenia - complications
Treatment Failure
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
title Factors associated with liver fibrosis in intravenous drug users coinfected with HIV and HCV
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