Injection drug users (IDUs) are at risk for several health consequences, including viral hepatitis, HIV, bacterial and fungal infections, and chronic liver disease. People who inject drugs (PWIDs) with hepatitis C, a liver disease caused by the hepatitis C virus (HCV), may develop an acute or chronic infection. Chronic hepatitis C can lead to liver disease, liver failure, liver cancer, and even death.

What is Liver Stiffness?

Liver stiffness measures the elasticity of soft tissue in the liver. Stiffness of the liver is often a sign of scar tissue (liver fibrosis) caused by liver disease. Liver stiffness is measured by transient elastography, an imaging test that quantitatively and noninvasively assesses soft biological tissue stiffness in the organs, specifically in the liver. Elastography can help identify the early signs of liver scarring and stiffness before the damage becomes severe and irreversible. Chronic hepatitis B and C are common conditions that increase the risk of liver stiffness and fibrosis in injection drug users.

Identifying liver stiffness in former drug injectors is a crucial metric, as it helps determine the patient’s extent of liver fibrosis and monitor the progression or regression of liver disease. Measurement of liver stiffness (LS) can indicate liver scarring (fibrosis) and cirrhosis, which is severe and extensive scarring.

former injection drug user with liver stiffness from drug and alcohol abuse

Major Risk Factors for Liver Stiffness in Injection Drug Users

Liver stiffness measurements (LSM) are commonly associated with various risk factors in people who inject drugs (PWID). Major risk factors can include injection drug use patterns, hepatitis C virus (HCV) infection, alcohol abuse, HIV co-infection, metabolic syndrome, and liver disease. People who inject drugs (PWID) are more susceptible to blood-borne infections, such as HIV, viral hepatitis, and other bacterial infections.

Hepatitis C Virus (HCV) Infection

Hepatitis C virus (HCV) in injection drug users is typically transmitted through sharing contaminated drug injection equipment like needles. Once the infection has spread, HCV can increase liver stiffness through chronic inflammation, fibrosis, and cirrhosis.

Alcohol Use and Liver Health

Alcohol use in injection drug users can have hepatoxic effects, including liver inflammation, fatty liver disease, and fibrosis. Alcohol-related liver disease (ALD) is due to excessive alcohol consumption over a period that is comprised of three stages. The three stages of ALD are alcohol-related fatty liver disease, alcohol-related hepatitis, and alcohol-related cirrhosis. Alcohol can exacerbate liver damage in injection drug users with HCV, facilitating the progression to cirrhosis.

liver stiffness in former injector, alcohol-related liver disease from drug and alcohol abuse

HIV Co-Infection

According to the CDC, people who inject drugs (PWID) account for about 1 in 10 HIV diagnoses in the US. HIV, also called human immunodeficiency virus, co-infection in injection drug users with HCV can accelerate the progress of liver disease. Antiretroviral therapy (ART) is used in the treatment of HIV and may contribute to liver toxicity and liver stiffness.

Metabolic Syndrome and Liver Disease

Metabolic syndrome is a combination of conditions that co-occur, increasing the risk of stroke, coronary heart disease, and type 2 diabetes. Also called insulin resistance syndrome, metabolic syndrome can occur in individuals with high blood pressure, high blood sugar levels, high blood triglycerides, and low HDL cholesterol. Individuals with a large waistline, also known as abdominal obesity, are at increased risk for heart disease.

Obesity, diabetes, and hypertension are common in people who inject drugs (PWID). Metabolic syndrome can lead to non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), which both increase liver stiffness.

Duration of Injection Drug Use

Individuals who have been injecting drugs for a more extended period and at a higher intensity are more susceptible to HCV and liver damage. Repeated substance use continuously harms the liver, eventually leading to chronic liver inflammation and fibrosis.

Health Implications of Liver Stiffness in Former Injectors

Former drug injectors with liver stiffness, often indicative of fibrosis or cirrhosis, have significant health implications. Associated health consequences of liver stiffness can affect various health aspects, leading to severe complications and decreased overall quality of life.

Progression to Liver Cirrhosis

Liver stiffness in former injection drug users is often a sign of progressive liver damage, such as fibrosis to cirrhosis. Advanced cirrhosis from injection drug users can lead to liver failure, requiring extensive treatment options.

Risk of Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC), the most common type of liver cancer, is most prevalent in individuals with chronic liver diseases. Cirrhosis, caused by hepatitis C virus (HCV) and liver stiffness, can lead to the development of primary liver cancer, such as HCC.

Development of Portal Hypertension

Portal hypertension, which is increased blood pressure in the portal venous system, is often caused by cirrhosis of the liver. Former drug injectors with portal hypertension are at risk of varices (varicose veins) in the esophagus or stomach, which can cause acute bleeding. Ascites, the buildup of fluid in the abdomen from chronic liver disease, can cause swelling, tiredness, and a feeling of fullness.

Liver-Related Mortality Rates

Increased liver stiffness in former injectors gave higher rates of liver-related mortality from health complications such as bleeding varices, liver failure, and liver cancer.

Compromised Liver Function

Liver stiffness can compromise the liver’s metabolic and detoxification abilities. These impairments can affect how the liver detoxifies harmful substances, processes nutrients, and produces essential proteins. Decreased liver function can also lead to jaundice, which causes yellowing of the eyes and skin.

Liver dysfunction from stiffness can lead to a buildup of toxins in the blood, which can impact brain function and lead to confusion and, potentially, coma. Impaired liver function can affect blood flow, leading to blood clotting and increasing the risk of bruising and bleeding.

man seeking drug detox and rehab for injection drug use

Extra-hepatic and Mental Health Complications

Former injectors with chronic liver stiffness are at a higher risk of cardiovascular diseases and kidney dysfunction, including hepatorenal syndrome. Poor nutritional habits in drug users can lead to malnutrition and metabolic changes, also linked to liver disease, which can lead to muscle weakness and wasting. Individuals with liver stiffness may experience chronic fatigue and weakness, which can affect their day-to-day routines and overall quality of life.

Former injectors may struggle with mental health issues alongside chronic illness, including depression, anxiety, and social isolation. Understanding the risk factors and health implications of liver stiffness in former injectors helps administer regular health monitoring and comprehensive treatment for liver disease.

South Florida Drug Detox and Rehabilitation for Injection Drug Use

Drug detox and rehab for injection drug use provide comprehensive treatment services for the physical and psychological aspects. Seeking treatment for drug abuse can help patients receive timely detox and therapeutic intervention to prevent any further health complications.

For drug and alcohol detox in Stuart, FL, reach out to one of our addiction specialists at Coastal Detox.