Noninvasive Assessment of Liver Fibrosis and Steatosis in HIV-Monoinfected Subjects

POSTER PRESENTATIONS Among patients with CHC, 58.9% were male, the mean age was 49 years, 47.2% patients had F0-F1-F2 fibrosis stage and 52.8% had F3-F4 fibrosis stage. The mean HCV viral load was 5.6 log UI/mL. The expression of hepatic and serum of miR-20a, -27b, -29a, -92a, -122, -146a, -222, -224, was assessed by RT-qPCR. Results: Serum miR-20a ( p = 0.01), -21 ( p < 0.0001), -29a ( p < 0.0001), -92a ( p = 0.017), -122 (p < 0.0001), -222 ( p = 0.008) was lower in CHC than in CHB patients. Serum miR-122 was 30-fold higher in CHB than in CHC patients ( p < 0.0001). Hepatic miR-21 ( p = 0.001), -92a ( p < 0.0001), -122 ( p < 0.0001), -146a ( p = 0.0002) was higher in CHC than in CHB. Inversely, hepatic miR-222 ( p < 0.0001) and -224 ( p = 0.003) were lower in CHC than in CHB. In CHB, hepatic and serum miRNAs were deregulated as described in Table 1. In multivariate analysis, serum miR-122 (OR = 0.19, 95% CI = 0.017–0.75) and miR-222 (OR = 1.1; 95% CI = 1–1.3), platelets count (OR = 0.99, 95% CI = 0.98–1) and alkaline phosphatase (OR = 1.2; 95% CI = 1.1–1.4) were significant predictors of F3-F4. The AUC of the CHB model was 0.86 while FIB-4 and APRI had an AUC of 0.81 and 0.70 respectively. In CHC, hepatic and serum miRNAs were deregulated as described in Table 1. In multivariate analysis, hepatic miR-122 (OR = 0.8; 95% CI = 0.64–0.92) and miR-224 (OR = 1.6; 95% CI = 1.2–2.5), platelets count (OR = 0.97, 95% CI = 0.95–0.99), albumin (OR = 1.4; 95% CI = 0.97–2.2) and alanine aminotransferase (OR = 1.1; 95% CI = 0.97–1.3) were predictors of F3-F4. The AUC of the CHC model was 0.90, FIB-4 and APRI had an AUC of 0.78 and 0.85 respectively.

a fast of at least six hours. Only values with 10 validated measurements and an interquartile range/mean <30% for values higher than 7.1 kilopascal (kPa) were considered reliable. Data were expressed as mean and standard deviation (SD), or median and interquartile range (IQR) as appropriate. Students t-test was used to compare the group differences; an equivalence analysis was performed to investigate the clinical significance of 0.5 kPa. Results: One hundred and fifteen HIV-monoinfected subjects [74 males and 41 females; mean age, 46.4 (SD:10.3) yrs; mean BMI, 24.0 (3.8) kg/m2; mean CD4 count, 649 (279) cells/mL; median length of antiretroviral medications, 54 (IQR:16–108) months] and 247 blood donors [155 males and 92 females; mean age, 41.9 (12.5) yrs; mean BMI, 23.7 (3.3) kg/m2] were studied. In HIV-monoinfected subjects the values of ALT, AST and GGT, respectively, were 21(15–29) IU/L, 24.6 (15.4) IU/L, and 30 (20–54) IU/L, and these values were not statistically different from those obtained in the blood donors. One failure in TE measurements was observed in the cohort of blood donors. All TE measurements were reliable. TE showed a value of 4.65 (1.06) kPa in HIV-monoinfected subjects and 4.27 (1.01) kPa in blood donors ( p = 0.001); on the other hand the study had more than 90% power to detect an equivalence of 0.5 kPa between the two groups. CAP values were 235 (46) decibel/meter in HIV-monoinfected subjects and 233 (53) decibel/meter in blood donors ( p = 0.72). Conclusions: These preliminary results show that HIV-monoinfected patients not immunosuppressed have significantly higher stiffness values than controls, however this difference is not clinically important. No significant difference in the degree of liver steatosis between patients and controls were observed. SAT-459 THE UTILITY OF FIBROELASTOGRAPHY TO DETECT ALCOHOLRELATED LIVER DISEASE IN A NURSE-LED OUTPATIENT ALCOHOL TREATMENT CLINIC L. Owens1,2, A. Thompson1, K. Mannix2, E. Lewis2, G. O’Hare2, L. Richardson2, P. Richardson2. 1Wolfson Centre for Personalised Medicine, University of Liverpool; 2Hepatology, Royal Liverpool & Broadgreen University Hospital Trust, Liverpool, United Kingdom E-mail: [email protected]

Conclusions: The two models are better predictors than FIB-4 and APRI to distinguish patients with F3-F4 compared to F1-F2. SAT-458 NONINVASIVE ASSESSMENT OF LIVER FIBROSIS AND STEATOSIS IN HIV-MONOINFECTED SUBJECTS G. Ferraioli1, L. Maiocchi1, R. Lissandrin1, C. Tinelli2, C. Filice1, the Study Group:, E. Above, G. Chieffo, S. Cima, P. Columpsi, G. Contardi, C. Dellafiore, M. Di Gregorio, R. Gulminetti, R. Maserati, S. Novati, G. Poma, P. Sacchi, D. Zanaboni. 1Infectious Diseases Dept., Fondazione IRCCS Policlinico San Matteo, University of Pavia; 2Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy E-mail: [email protected] Background and Aims: It has been reported that HIV-infected patients are at risk of liver fibrosis due to antiretroviral medications and immunosuppression. The aim of this study was to assess liver stiffness by transient elastography (TE) and liver steatosis by means of controlled attenuation parameter (CAP) in a cohort of HIVmonoinfected subjects and to compare the results to those obtained in a large cohort of healthy volunteers who were blood donors. Methods: HIV-infected subjects, negative for hepatitis B surface antigen and hepatitis C antibody, and a control group of blood donors were consecutively enrolled. TE and CAP measurements were carried out by using the FibroScan device (Echosens, Paris, France) following

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Background and Aims: In the last 10 yrs the UK has experienced a 62% increase in liver disease with 1/3 of all deaths from liver disease attributed to alcohol. It is Important to highlight that all of these deaths are preventable. However, alcohol-related liver disease (ALD) is often not diagnosed until damage is irreversible. Therefore, we need to develop systems of care that increase the detection of ALD at the earliest stages. We suggest that fibroelastography may be a useful tool in a nurse-led outpatient Alcohol Treatment Clinic (ATC), to maximise early detection of ALD in a high risk population and affording opportunities to intervene and prevent subsequent mortality and death. To determine the clinical utility of performing fibroelastography in an ATC to identify the presence of liver fibrosis. Methods: An observational prospective clinical audit was performed. Primary outcome measures were; the number of individuals where fibrosis was detected in the a) absence of abnormal liver biochemistry, b) presence of abnormal liver biochemistry defined as a raised ALT or GGT ≥3× normal. Setting: Acute hospital nurse-led outpatient Alcohol Treatment Clinic. Participants: 296 patients with alcohol-use disorders and no previous history of cirrhosis. Results: Of the 296 patients; 136 female; 160 male; with a mean age of 47 years (SD = 10). Median alcohol consumption was 24 units per day (IQR = 15). Eightynine (30.1%) patients showed no evidence for abnormal liver biochemistry of these 55 (61.8%) had no evidence of fibrosis (<6.5 kpa), 17 (19.1%) showed F1/2 fibrosis (≥6.5 <11 kpa), 17 (19.1%) showed F3/4 fibrosis (≥11 kpa) meeting criteria for referral to hepatology. In total 34 (38.2%) patients had an abnormal fibroscan with no significant liver biochemistry. Twohundred and seven (69.9%) patients had abnormal liver biochemistry of which 72 (34.7%) had no evidence of fibrosis (<6,5 kpa), 51 (24.6) showed

Journal of Hepatology 2016 vol. 64 | S631–S832