Hepcheck Dublin: homeless, hepatitis C & competing priorities

POSTER PRESENTATIONS fairly small fraction of men above the age of 65 would qualify. Our data raise interesting questions regarding the meaning of “elevated” liver values. The prognostic value of ALT and GGT for health risks could perhaps be improved if upper limits of normal were to take age into account. This needs to be tested in clinical studies. FRI-466 Hepcheck Dublin: homeless, hepatitis C & competing priorities J.S. Lambert1, C. Murphy1,2, D.L. Menezes1, W. Cullen2, T. McHugh1, A. O’Carroll3. 1Mater Misericordiae University Hospital; 2University College Dublin; 3Safetynet Primary Care Network, Dublin, Ireland E-mail: [email protected] Background and Aims: The Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide. Research previously undertaken suggests the rates of HCV amongst homeless people remains largely unknown. This study aimed to establish the effectiveness of intensified screening for HCV in individuals attending homelessness services in Dublin. Methods: The target population was homeless people accessing the Safetynet primary healthcare services in Dublin. Individuals were invited to undertake a short questionnaire and HCV antibody test. Qualitative interviews were also carried out with selected patients (n = 49) exploring a broader range of health and lifestyle issues. Results: 619 individuals were offered screening, of which 216 reported having had a previous HCV test (108 positive, 108 negative and 29 unsure of the result). 547 HCV Ab tests were actually carried out with 38% (206) testing positive, 57% (310) negative and 6% (31) recorded as no result/awaiting result. Of the 206 testing positive, 54% (112) were “new” positives, in that they did not report having had a previous positive HCV AB test, while the remaining were “known positives”. Following a positive test, 51 patients were referred to specialist care of which 33 did not attend. The most common reasons for non-attendance were active on-going drug use, being in prison, fear of side effects of treatment and forgetfulness. Asked about barriers to treatment, participants’ answers centred around on-going drug use, mental health issues and lack of stable accommodation. Conclusions: Community based screening interventions are effective in determining the prevalence of HCV in homeless populations however, referrals to secondary care are suboptimal for this cohort. The HepCheck study was carried out during a homelessness crisis in Dublin. Sourcing accommodation on a nightly basis was an unfortunate reality for many of the participants, with many additionally experiencing addiction and mental health issues. Considering the range and magnitude of barriers faced by this cohort in accessing hospital-based services, outreach community based treatment provision alongside effective referral into onward care is the primary goal for HCV screening and treatment, in order for this hard to reach group to receive the treatment they need. FRI-467 Effectiveness of DAA-based treatment of HCV in active people who inject drugs living in middle income countries (MIC): the results of a prospective cohort study in Tbilisi, Georgia J. Bouscaillou1, T. Kikvidze2, M. Butsashvili3, K. Labartkava4, I. Inaridze2, A. Etienne1, G. Kamkamidze3, A. Gamezardashvili3, E. Avril5, N. Luhmann1. 1International Operations Division, Médecins du Monde, Paris, France; 2Médecins du Monde; 3Health Research Union; 4 New Vector, Tbilisi, Georgia; 5Médecins du Monde, Paris, France E-mail: [email protected] Background and Aims: Although they carry a high HCV burden globally, active people who inject drugs (PWID) are often excluded from national policies due to concerns about their ability to adhere to care, especially in MIC. Georgia faces high HCV rates (7.1% of antibodies in general population) with 25.6% of the cases being among PWID. An ambitious National HCV elimination Plan was launched in 2015, with initially 7,000 treatments dedicated to patients with advanced liver fibrosis (≥F3). We assessed the

treatment outcomes in PWID treated in the framework of the National Plan. Methods: We followed a prospective cohort of PWID clients of a needle and syringe exchange program and supported by peer workers during treatment. PWID were treated with sofosbuvir and ribavirin +/−pegInterferon according to the genotype, treatment experience and level of fibrosis. We collected data concerning biomedical parameters, adherence to care, demographics, and behaviors before and during treatment. After a descriptive analysis, we studied the factors associated with adherence to care and sustained virologic response at 12 weeks post-treatment (SVR12) using adjusted logistic regressions. We additionally compared the SVR12 rate to those of patients not reporting any history of injecting drug use (non-PWID), treated at the same clinic, during the same period – adjusting for age, sex, genotype, level of fibrosis, and treatment regimen. Results: We included 244 PWID in the 2nd semester of 2015. Mean age was 46.3 years, 0.8% were women, 54.5% had cirrhosis (liver stiffness ≥14 kPa or Fib 4 > 3.25). Genotypes were distributed as follows: 18.9%, 25.4%, 51.6%, and 4.1% for genotype 1, 2, 3 and mixed genotypes, respectively. 2% (n = 5) had to prematurely stop the treatment, due to serious adverse events. Amongst the others, 88.7% never missed any of the bimonthly medical appointments, 79.1% never missed a dose of medication, and 88.2% reached SVR12. Only cirrhosis (adjusted odd ratio (aOR) 0.28; 95% confidence interval (95CI) 0.10–0.83) was significantly associated with SVR12. Ongoing drug use during treatment was associated with delaying medical appointments, but not with observance nor SVR12. SVR12 rate (80.7%) was not significantly different in the 223 non-PWID (aOR 0.94; 95CI 0.50–1.75 compared to PWID) treated at the same time.

Conclusions: In this real life experience, PWID were adherent to care and had SVR12 rates similar to those observed in non-PWID. Concerns about PWID ability to engage in care should not be a reason of exclusion from HCV treatment in Georgia. FRI-468 Smoking and metabolic syndrome components are independent predictors of mortality in patients with chronic liver disease in the United States K. Wijarnpreecha1, M. Scribani2, P. Ungprasert3,4, N. Merrell5, P. Raymond5. 1Medicine, Bassett Medical Center; 2Research Institute, Bassett Medical Center, Cooperstown; 3Medicine, Mayo Clinic, Rochester, United States; 4Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 5Gastroenterology and Hepatology, Bassett Medical Center, Cooperstown, United States E-mail: [email protected] Background and Aims: Chronic liver disease (CLD) is one of the major causes of mortality and morbidity worldwide. This study assessed the association between CLD and overall mortality, and predictors of mortality among CLD patients, from population-based data.

Journal of Hepatology 2017 vol. 66 | S333–S542

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