[16] A sample size of 230 ex-IDUs would determine the prevalence of HCV infection with a confidence interval of 6.4% at a 95% confidence level. Statistical tests were selleck chemical performed using the Statistical Package for Social Science (SPSS version 20.0, Chicago, IL). Continuous variables were reported in mean (standard deviation [SD]) or median (interquartile range [IQR]) and compared between patients who attended and defaulted follow-ups using unpaired t-test and

Mann–Whitney U-test as appropriate. Categorical variables were compared using the chi-square test or Fisher exact text. A two-sided P value of < 0.05 was taken as statistically significant. From November 2009 to October 2012, we organized 10 education and screening sessions at four urban rehabilitation centers and served 234 subjects. Together, the four centers were actively serving around 400 ex-IDUs. The group size ranged from 8 to 40 subjects. Overall, www.selleckchem.com/products/NVP-AUY922.html 130 subjects tested positive for anti-HCV, with a prevalence of 56% (95% confidence

interval, 49–62%). The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6–2.0). One hundred eleven (85%) patients with HCV infection consented to the study and attended the first assessment session (Fig. 1). Most patients were middle-aged men with little education (Table 1). Ninety-seven (87%) patients reported that they did not know the diagnosis of HCV infection before attending the program. The majority of this cohort had genotype

1b and 6a HCV infection (Table 1). The mean HCV RNA was 5.2 (SD 2.3) log IU/mL, and 98 (88%) patients had detectable HCV RNA. One hundred nine (98%) patients had reliable liver stiffness measurements. Twenty-eight (26%) of them had liver stiffness above 7.9 kPa, a level suggestive of selleck inhibitor significant fibrosis or cirrhosis. Fifteen (14%) had liver stiffness above 11.9 kPa, a level suggestive of cirrhosis. At study entry, all patients had compensated liver disease. However, during a mean follow-up of 32 (SD 12, range 10–46) months, three patients developed HCC at 4, 17, and 18 months. They were treated with transarterial chemoembolization, radiofrequency ablation, and sorafenib, respectively. The patient on sorafenib died of liver failure 5 months after the diagnosis of HCC. In addition, one patient died of aortic dissection, one died of carcinoma of lung, and two were found cardiac arrest at home with no identified apparent cause. Of 111 patients who underwent liver assessment and were referred to the regional hospitals, 69 (62%) attended subsequent follow-up. Patients who attended follow-up were older, had higher education level, and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness (Table 1). Twenty-six (23%) patients received peginterferon and ribavirin treatment, of whom nine (35%) required dose adjustment, and six (23%) terminated treatment prematurely.