Hepatitis B testing in a large cohort of U.S. hepatitis C virus-infected patients

POSTER PRESENTATIONS HIV-infected population does not seem to be a major public health issue in these settings. Nevertheless, data on specific high-risk groups such as intravenous drug users are still lacking. Our results underscore the need to target screening for HCV infection among high-risk groups. THU-188 Hepatitis B testing in a large cohort of U.S. hepatitis C virus-infected patients A.C. Moorman1, X. Xing1, L.B. Rupp2, S.C. Gordon2, J.A. Boscarino3, Y. Daida4, M. Lu2, M.A. Schmidt5, S.D. Holmberg1 and for the CHeCS Investigators. 1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta; 2Henry Ford Health System, Detroit, MI; 3 Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, PA; 4Kaiser Permanente Hawaii Center for Health Research, Honolulu, HI; 5Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States E-mail: [email protected] Background and Aims: The rare emergence of hepatitis B virus (HBV) reactivation among hepatitis C virus (HCV)-infected patients receiving direct-acting antiviral (DAA) therapy raises questions about how many HCV-infected patients have active, past, or latent/occult HBV co-infection that might be reactivated from the therapy. Methods: Analysis of hepatitis serologic and DNA assays for HBV, as performed in a large cohort of patients with confirmed chronic HCV infection in the United States (Chronic Hepatitis Cohort Study [CHeCS]) who had healthcare visits during 2006 through 2014. Laboratory data were collected from the patient’s first available electronic health record through 2014. Results: Among 12,034 HCV-infected patients, 4,937 (41%) were ever tested for anti-hepatitis B (HB) core (anti-HBc, indicative of previous infection) of whom 2,234 (45%) were positive; of 7,413 (62%) tested for anti-HB surface antibody (anti-HBs, indicative of previous vaccination or infection), 2,646 (36%) were positive; and of 9,432 (78%) tested for HB surface antigen (HBsAg) or HBV DNA (indicative of current active infection), 216 (2.3%) ever had at least one positive test. Restricting analyses to 9,834 living HCV-infected patients, results as of 2014 were essentially the same; overall 6% were “isolated” antiHBc positive (Table). Men and older persons were significantly ( p < 0.05) more likely to be anti-HBc positive ( previous infection); younger persons more likely anti-HBs positive (immune; previously vaccinated or resolved infection); and men were more likely HBsAg positive or had detectable HBV DNA.

Conclusions: Very low prevalence of active HBV coinfection in this cohort (2.3%) is inconsistent with very high (total) anti-hepatitis B core test results (45% of those tested) suggesting that almost half of these tested HCV patients may have been infected with HBV at one time. Studies investigating incidence of hepatitis B in persons who inject drugs, but are not HCV infected may clarify how many of these anti-HBc positive tests seen in HCV-infected persons are “false positives.” THU-189 An audit of hepatitis C screening and referral patterns to a specialist hepatology service in a secondary care facility in the UK J. Shearer1, A. Pratt1, J. Hutchinson1, N. Todd2, C. Millson1. 1Hepatology; 2 Microbiology, York Teaching Hospitals NHS Foundation Trust, York, United Kingdom E-mail: [email protected] Background and Aims: The number of individuals screened for hepatitis C (HCV) has increased by 21% in the past 5 years. A study looking at HCV testing at York Teaching Hospital NHS Foundation Trust in 2013 demonstrated that 40% of positive HCV serology requests were duplicates and 66% of the new positive results were not clinically acted upon. The aim of this audit was to determine if the launch of a specialist Hepatology service at York Teaching Hospital NHS Foundation Trust improved the screening and assessment of HCV patients. Methods: Using the hospital Laboratory Information Management System, HCV serology requests were examined between October 2015 and September 2016 at York. Patient outcomes were determined using the hospital clinical database.

Table: Hepatitis B testing results in 9,834 HCV-infected patients, living as of January 2014 TYPE OF ASSAY USED (Number [%]) Anti HBc (total) (N = 3,907 [40%]; 605 [6%] were “isolated” AntiHBc positive with negative HBsAg and

HBsAg and/or Anti- HBs (N = 5,997

HBV DNA

[61%])

(N = 7,511 [76%])

anti-HBs) Positive (%)

Positive Negative

(%)

Positive Negative

(%)

Negative

Gender Male

1,179 (47)

1,305

1,247 (35)

2,324

117 (2.6)

4,312

Female

499 (35)

911

876 (36)

2,521

55 (1.8)

3,027

(yrs) <30

3 (5)

62

130 (74)

45

4 (1.7)

225

31–40

31 (20)

123

135 (43)

180

15 (3.0)

477

41–50

136 (30)

321

252 (35)

470

24 (2.6)

895

51–60 >60

574 (39) 934 (54)

899 810

740 (33) 866 (35)

1,534 1,616

64 (2.2) 65 (2.2)

2,750 2,894

Age Group

Results: The results are demonstrated in Figure 1. In total, 6623 requests for HCV serology were identified. Of these 2342 (35.4%) requests were duplicates. At a cost of £10.62 per individual serology test, a total cost of £24,872.04 in duplicate tests was incurred at York over this 12 month period. Of the remaining 4281 HCV serology requests, 4149 (96.9%) were negative and 132 (3.1%) were positive. Of

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