- Email: [email protected]
361 USEFULNESS OF FIBROTEST AND FIBROSCAN FOR THE DIAGNOSIS OF HBs Ag INACTIVE CARRIAGE
S138
Poster Session − Thursday, April 23
group were divided according to the viral loads, HBeAg and maternal HBsAg status. Results: The association with the susceptibility to HBV infection was only observed for IL10-RB K47E when we compared the individuals with persistent HBV infection through non-maternal transmission to the controls with asymptomatic self-limited HBV infection. Further, we found that the IFNAR2−8SS genotype was associated with HBeAg negative patients (OR = 0.316, 95% CI: 0.121−0.825, p = 0.019) and that the IFNAR2−8F allele was associated with the risk to high viral loads (OR = 1.667, 95% CI: 1.148–2.420, p = 0.007). In addition, the IFNAR2−8FF genotype predisposed to higher MxA gene induction and correlated with good interferon response (OR = 0.348, 95% CI: 0.129–0.935, p = 0.036). Haplotype analysis based on polymorphisms of three SNPs, MxA −88 G/T, IFNAR-2 F8S and IL10RB K47E showed that the haplotype distribution was significantly different between the SVR and NR groups (p = 0.040). Conclusion: This study found that IFNAR2 play an important role in determining interferon response and clinical phenotypes of HBV infection in the Chinese Han population. 361 USEFULNESS OF FIBROTEST AND FIBROSCAN FOR THE DIAGNOSIS OF HBs Ag INACTIVE CARRIAGE M.N. Hilleret1 , A. Cheveau1 , J.C. Renversez2 , N. Sturm3 , J.P. Zarski1 , V. Leroy1 . 1 Clinique Universitaire d’H´epatogastroent´erologie, 2 DBI, Pole Biologie, 3 Laboratoire de Pathologie Cellulaire, CHU de Grenoble, Grenoble, France E-mail: [email protected] The diagnosis of HBs Ag inactive carriage is based on low HBV DNA levels (without any validated viral load threshold), HBeAg negativity and persistent normal ALT. In absence of liver biopsy, this status can be difficult to distinguish from HBe Ag − hepatitis B. Utility of non invasive tests of fibrosis is not well documented. Methods: 117 HBs Ag inactive carriers consecutively seen in our center between 2003 and 2007 were included. HBs Ag inactive carrier status was defined as follow: HBs Ag+, HBe Ag−, Anti-Hbe+, ALT < N at least at three occasions within a minimal 6 month follow-up, HBV DNA lower than 4,000 IU/ml, anti-HCV and delta negative. They were compared to 174 patients seen during the same period with histologically proven HBe Ag− chronic hepatitis B. For each patient both transient elastography (Fibroscan) and Fibrotest were performed. Results: Inactive carriers were significantly younger (37 vs 41 years, p < 0.01) and had lower ALT serum levels (25 IU/ml vs 89 IU/ml; p < 0.0001), HBV DNA (346 vs 2620 UI/ml; p < 0.01), Fibrotest (0.15 vs 0.39; p < 0.001) and Fibroscan values (4.9 vs 8.6 kPa; p < 0.001) than chronic HBV patients. Fibrotest and Fibroscan were then compared between inactive carriers (excluding inactive cirrhosis) and patients with mild HbeAg− chronic hepatitis B (METAVIR F0/F1, N = 87). Both Fibrotest and Fibroscan values were significantly lower in inactive carrier group: 0.15 vs 0.28, p < 0.0001 and 4.9 vs 8.1 kPa, p < 0.03, respectively. In inactive carriers, Fibrotest indicated F0 (<0.21) in 81.6% of cases. Among them, 95.6% had a Fibroscan score lower than 7 kPa, confirming absence of significant fibrosis. In the 17 patients with Fibrotest >0.21, 5 (29.4%) had Fibroscan higher than 7 kPa. These patients had Fibrotest ranging from 0.23 to 0.33 and Fibroscan from 7.2 to 10.4 kPa, suggesting significant fibrosis. They were significantly older (50 vs 35 years, p < 0.03) than patients without fibrosis. Conclusions: Fibrotest (indicating F0) has an excellent specificity for the diagnosis of HBs Ag inactive carriage and can be used as first line fibrosis marker.
362 VALIDATION AND COMPARISON OF INDEXES FOR DETECTING COMPENSATED CIRRHOSIS IN PATIENTS WITH CHRONIC HEPATITIS B: A PROSPECTIVE STUDY Y.-P. Chen, J.-L. Hou. Dept. of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China E-mail: [email protected] Aim: Several models for detecting cirrhosis had been introduced for hepatitis C and B. This study prospectively analyzed patients’ data to validate and compare these models’ diagnostic value. Methods: Five-hundred and sixty-three consecutive patients with compensated chronic hepatitis B were included, which had received liver biopsies, ultrasonography scanning and routine blood tests. Among them, 225 patients were also received liver stiffness measurement (LSM). Indexes for cirrhosis prediction in hepatitis B and C were involved for validating comparison. Area under receiver-operating characteristics curves (AUC) and diagnostic predictive values for indexes were calculated. Results: Patients’ mean age was 30.4±8.75 years, 78.7% were males, and 20.8% were cirrhosis by METAVIR system. Liver biopsies mean size and number of portal tracts was 21.7±7.24 mm and 26±11.8, respectively. Fibrosis stages and LSM, age-ultrasonic-platelet-albumin-bilirubin index (AUPABI), age-platelet index (API), aspartate aminotransferaseplatelet ratio index (APRI) and aspartate-alanine aminotransferase ratio (AAR) were correlated, with rank correlation coefficients Kendall’s tau_bs 0.567, 0.346, 0.290, 0.264 and 0.135 (P = 0.000), respectively. Respective AUCs of LSM, AUPABI, API, APRI and AAR for diagnosing cirrhosis were 0.887 (95% confidence interval: 0.834−0.940), 0.823 (0.78−0.865), 0.765 (0.719−0.812), 0.678 (0.626−0.730) and 0.659 (0.605−0.865). LSM < 11.0 kPa and LSM 18.2 kPa excluded and determined cirrhosis with negative predictive value (NPV) 96.5% and positive predictive value (PPV) 63.2%, respectively. Only 5.3% of patients with LSM 18.2 kPa were mild fibrosis (F1, F2). Thus, nearly 80% of patients were well predicted and free from biopsy. With AUPABI < −0.96, 174 (32%) patients were determined absence of cirrhosis with 96.6% possibility. AUPABI 1.40 diagnosed 80 (14.8%) patients as cirrhosis with 72.5% possibility, and 6.3% of them were F1 and F2 fibrosis. By AUPABI, about 47% of patients were well determined absence or presence of cirrhosis without biopsy. For API, only 27.8% of patients with API < 2 could be excluded from cirrhosis with NPV 95.5%. Conclusion: In indexes for prediction hepatitis B cirrhosis, LSM was the most accurate index; AUPABI was confirmed to be of moderate value. Indexes for hepatitis C fibrosis discrimination may be of little value in hepatitis B cirrhosis prediction.
363 FREQUENT REACTIVATION OF HEPATITIS B VIRUS AMONG PATIENTS WITH HEPATOCELLULAR CARCINOMA UNDERGOING INTENSIVE TRANSARTERIAL THERAPY: A PROSPECTIVE COMPARISON ANALYSIS J.W. Jang, C.R. You, J.D. Kim, C.W. Kim, J.Y. Choi, S.H. Cho, J.Y. Han, J.M. Yang, S.W. Choi, C.D. Lee, Y.S. Lee. The Catholic University of Korea, Seoul, South Korea E-mail: [email protected] Background and Aims: The occurrence of hepatitis B virus (HBV) reactivation in patients with hepatocellular carcinoma (HCC) undergoing loco-regional therapy is known to be less frequent than that of those with hematological malignancies receiving systemic chemotherapy (24% vs. 38−48%) (Yeo, Hapatology 2006). However, the true incidence of HBV reactivation among HCC patients remains unknown, because of only a limited dataset available on this subject; No study has addressed prospectively viral reactivation and hepatic morbidity occurring during varying modes of loco-regional therapy. This study aimed at comparing HBV-related hepatic morbidity and assessing potential benefits of pre-emptive antiviral therapy according to different treatment modalities for HCC. Methods: A total of 142 antiviral-naive patients with HBV-related HCC undergoing loco-regional therapies were prospectively included in the
Poster Session − Thursday, April 23
group were divided according to the viral loads, HBeAg and maternal HBsAg status. Results: The association with the susceptibility to HBV infection was only observed for IL10-RB K47E when we compared the individuals with persistent HBV infection through non-maternal transmission to the controls with asymptomatic self-limited HBV infection. Further, we found that the IFNAR2−8SS genotype was associated with HBeAg negative patients (OR = 0.316, 95% CI: 0.121−0.825, p = 0.019) and that the IFNAR2−8F allele was associated with the risk to high viral loads (OR = 1.667, 95% CI: 1.148–2.420, p = 0.007). In addition, the IFNAR2−8FF genotype predisposed to higher MxA gene induction and correlated with good interferon response (OR = 0.348, 95% CI: 0.129–0.935, p = 0.036). Haplotype analysis based on polymorphisms of three SNPs, MxA −88 G/T, IFNAR-2 F8S and IL10RB K47E showed that the haplotype distribution was significantly different between the SVR and NR groups (p = 0.040). Conclusion: This study found that IFNAR2 play an important role in determining interferon response and clinical phenotypes of HBV infection in the Chinese Han population. 361 USEFULNESS OF FIBROTEST AND FIBROSCAN FOR THE DIAGNOSIS OF HBs Ag INACTIVE CARRIAGE M.N. Hilleret1 , A. Cheveau1 , J.C. Renversez2 , N. Sturm3 , J.P. Zarski1 , V. Leroy1 . 1 Clinique Universitaire d’H´epatogastroent´erologie, 2 DBI, Pole Biologie, 3 Laboratoire de Pathologie Cellulaire, CHU de Grenoble, Grenoble, France E-mail: [email protected] The diagnosis of HBs Ag inactive carriage is based on low HBV DNA levels (without any validated viral load threshold), HBeAg negativity and persistent normal ALT. In absence of liver biopsy, this status can be difficult to distinguish from HBe Ag − hepatitis B. Utility of non invasive tests of fibrosis is not well documented. Methods: 117 HBs Ag inactive carriers consecutively seen in our center between 2003 and 2007 were included. HBs Ag inactive carrier status was defined as follow: HBs Ag+, HBe Ag−, Anti-Hbe+, ALT < N at least at three occasions within a minimal 6 month follow-up, HBV DNA lower than 4,000 IU/ml, anti-HCV and delta negative. They were compared to 174 patients seen during the same period with histologically proven HBe Ag− chronic hepatitis B. For each patient both transient elastography (Fibroscan) and Fibrotest were performed. Results: Inactive carriers were significantly younger (37 vs 41 years, p < 0.01) and had lower ALT serum levels (25 IU/ml vs 89 IU/ml; p < 0.0001), HBV DNA (346 vs 2620 UI/ml; p < 0.01), Fibrotest (0.15 vs 0.39; p < 0.001) and Fibroscan values (4.9 vs 8.6 kPa; p < 0.001) than chronic HBV patients. Fibrotest and Fibroscan were then compared between inactive carriers (excluding inactive cirrhosis) and patients with mild HbeAg− chronic hepatitis B (METAVIR F0/F1, N = 87). Both Fibrotest and Fibroscan values were significantly lower in inactive carrier group: 0.15 vs 0.28, p < 0.0001 and 4.9 vs 8.1 kPa, p < 0.03, respectively. In inactive carriers, Fibrotest indicated F0 (<0.21) in 81.6% of cases. Among them, 95.6% had a Fibroscan score lower than 7 kPa, confirming absence of significant fibrosis. In the 17 patients with Fibrotest >0.21, 5 (29.4%) had Fibroscan higher than 7 kPa. These patients had Fibrotest ranging from 0.23 to 0.33 and Fibroscan from 7.2 to 10.4 kPa, suggesting significant fibrosis. They were significantly older (50 vs 35 years, p < 0.03) than patients without fibrosis. Conclusions: Fibrotest (indicating F0) has an excellent specificity for the diagnosis of HBs Ag inactive carriage and can be used as first line fibrosis marker.
362 VALIDATION AND COMPARISON OF INDEXES FOR DETECTING COMPENSATED CIRRHOSIS IN PATIENTS WITH CHRONIC HEPATITIS B: A PROSPECTIVE STUDY Y.-P. Chen, J.-L. Hou. Dept. of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China E-mail: [email protected] Aim: Several models for detecting cirrhosis had been introduced for hepatitis C and B. This study prospectively analyzed patients’ data to validate and compare these models’ diagnostic value. Methods: Five-hundred and sixty-three consecutive patients with compensated chronic hepatitis B were included, which had received liver biopsies, ultrasonography scanning and routine blood tests. Among them, 225 patients were also received liver stiffness measurement (LSM). Indexes for cirrhosis prediction in hepatitis B and C were involved for validating comparison. Area under receiver-operating characteristics curves (AUC) and diagnostic predictive values for indexes were calculated. Results: Patients’ mean age was 30.4±8.75 years, 78.7% were males, and 20.8% were cirrhosis by METAVIR system. Liver biopsies mean size and number of portal tracts was 21.7±7.24 mm and 26±11.8, respectively. Fibrosis stages and LSM, age-ultrasonic-platelet-albumin-bilirubin index (AUPABI), age-platelet index (API), aspartate aminotransferaseplatelet ratio index (APRI) and aspartate-alanine aminotransferase ratio (AAR) were correlated, with rank correlation coefficients Kendall’s tau_bs 0.567, 0.346, 0.290, 0.264 and 0.135 (P = 0.000), respectively. Respective AUCs of LSM, AUPABI, API, APRI and AAR for diagnosing cirrhosis were 0.887 (95% confidence interval: 0.834−0.940), 0.823 (0.78−0.865), 0.765 (0.719−0.812), 0.678 (0.626−0.730) and 0.659 (0.605−0.865). LSM < 11.0 kPa and LSM 18.2 kPa excluded and determined cirrhosis with negative predictive value (NPV) 96.5% and positive predictive value (PPV) 63.2%, respectively. Only 5.3% of patients with LSM 18.2 kPa were mild fibrosis (F1, F2). Thus, nearly 80% of patients were well predicted and free from biopsy. With AUPABI < −0.96, 174 (32%) patients were determined absence of cirrhosis with 96.6% possibility. AUPABI 1.40 diagnosed 80 (14.8%) patients as cirrhosis with 72.5% possibility, and 6.3% of them were F1 and F2 fibrosis. By AUPABI, about 47% of patients were well determined absence or presence of cirrhosis without biopsy. For API, only 27.8% of patients with API < 2 could be excluded from cirrhosis with NPV 95.5%. Conclusion: In indexes for prediction hepatitis B cirrhosis, LSM was the most accurate index; AUPABI was confirmed to be of moderate value. Indexes for hepatitis C fibrosis discrimination may be of little value in hepatitis B cirrhosis prediction.
363 FREQUENT REACTIVATION OF HEPATITIS B VIRUS AMONG PATIENTS WITH HEPATOCELLULAR CARCINOMA UNDERGOING INTENSIVE TRANSARTERIAL THERAPY: A PROSPECTIVE COMPARISON ANALYSIS J.W. Jang, C.R. You, J.D. Kim, C.W. Kim, J.Y. Choi, S.H. Cho, J.Y. Han, J.M. Yang, S.W. Choi, C.D. Lee, Y.S. Lee. The Catholic University of Korea, Seoul, South Korea E-mail: [email protected] Background and Aims: The occurrence of hepatitis B virus (HBV) reactivation in patients with hepatocellular carcinoma (HCC) undergoing loco-regional therapy is known to be less frequent than that of those with hematological malignancies receiving systemic chemotherapy (24% vs. 38−48%) (Yeo, Hapatology 2006). However, the true incidence of HBV reactivation among HCC patients remains unknown, because of only a limited dataset available on this subject; No study has addressed prospectively viral reactivation and hepatic morbidity occurring during varying modes of loco-regional therapy. This study aimed at comparing HBV-related hepatic morbidity and assessing potential benefits of pre-emptive antiviral therapy according to different treatment modalities for HCC. Methods: A total of 142 antiviral-naive patients with HBV-related HCC undergoing loco-regional therapies were prospectively included in the