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Systematic screening in an ongoing cross-sectional epidemiological study on hepatitis C high-risk populations in Trondheim city, Norway
POSTER PRESENTATIONS current national guidelines, but most had not sought help in the local health care system. This study demonstrates that establishing an outreach system for HCV screening among PWID in a defined geographical area is feasible and should be considered to increase treatment uptake among at-risk population s. FRI-481 Prevalence of end of life criteria in patients with liver disease in South West England U. Thalheimer1, V. Giannelli2. 1Department of Gastroenterology, Royal Devon and Exeter Hospital, Exeter, United Kingdom; 2UOC Malattie del Fegato, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy E-mail: [email protected]
FRI-480 Systematic screening in an ongoing cross-sectional epidemiological study on hepatitis C high-risk populations in Trondheim city, Norway T. Svendsen1, M. Skaland1, S. Zinöcker2, R. Hannula1. 1Department of Infectious Diseases , St Olavs Hospital, Trondheim; 2AbbVie, Oslo, Norway E-mail: [email protected] Background and Aims: Globally, the morbidity and mortality attributable to hepatitis C virus (HCV) infection is increasing. The nature and magnitude of the hepatitis C epidemic is poorly described in most countries, including Norway. Reliable epidemiological data are essential when planning health programs for treatment and prevention, especially targeting persons who inject drugs (PWID) who are most at risk of becoming infected and infecting others. The main aim of this ongoing study is to assess the prevalence of HCV in high- risk populations. Methods: In this study, we implemented mobile, on-site HCV screening to reach at-risk populations in Trondheim, Norway. Inclusion started in September 2015. Two dedicated study nurses frequently visited the local opioid substitution clinic, outpatient clinics and day centres for PWID, as well as the local prison and refugee healthcare centre. Demographic data, risk behavior and clinical symptoms were obtained by a study questionnaire. Subjects with a positive anti-HCV rapid test we resubsequently tested for serum HCV RNA and the virus genotype d. Subjects with detectable HCV RNA were offered transient liver elastography using a mobile FibroScan402 unit. Results: Recruitment of PWID was time-consuming. Word-of-mouth within the targeted population seemed to impact recruitment. By November 2016, 304 people had been tested. 148 (41%) had a positive HCV rapid test result, and of these, 90 (73%) were also HCV RNA positive. 102 had been injecting drugs; for over 10 years, 4 were cirrhotic (≥12.5 kPa or higher). HCV genotypes 1a (29%) and 3 (59%) were most prevalent. Of 25 subjects previously treated, 8 had detectable HCV RNA (32%), 3 of these were likely reinfected. None of the 52 immigrants were HCV positive. 32 of the 62 subjects included while in prison had a history of intravenous drug use, and HCV prevalence was similar to PWID outside of prison. All except one person wished to be evaluated for treatment, however, many failed to keep follow-up appointments. Conclusions: PWID have a high prevalence of HCV, but only 17% of HCV positive PWID had previously been treated. 22 study participants should have been considered for treatment according to
Background and Aims: Liver disease is an increasing cause of death in England, yet end of life care is used infrequently in patients with cirrhosis. Our aim was to assess the prevalence of factors of poor prognosis and need for end of life care in patients with liver disease. Methods: Over 3 months, we assessed patients seen in our liver clinic for of any of 11 end of life criteria (EOLC), and assessed their WHO performance status. EOLC considered were hepatorenal syndrome, SBP/severe infection, encephalopathy (any of these within the last year), refractory ascites, Child Pugh class C, severe malnutrition, recurrent variceal bleeding, 2 or more non elective hospital admissions for liver disease, consideration for liver transplantation, hepatocellular carcinoma and ongoing alcohol intake despite previous decompensation/alcoholic hepatitis. Results: 650 individual patients were seen at 785 clinic appointments. 580 patients had liver disease and 208 (32%) had cirrhosis. Aetiology in Table 1. EOLC were present in 71 patients with cirrhosis (34%) (48 male, 23 female), but in only 8 patients without cirrhosis (2%). 36 patients with cirrhosis (17%) met more than 1 EOLC. The most commonly met EOLC were ongoing alcohol use (13%), two or more non elective admissions in the previous 6months (11%), severe malnutrition (8%) and encephalopathy (7%). WHO performance score was worse in patients who met EOLC (Table 2). In patients with liver disease but not cirrhosis the average WHO score was 0.15, in patients with cirrhosis without EOLC 0.42 and in patients with cirrhosis and EOLC 0.97. Patients with 4 or more EOLC were more likely to be considered for liver transplantation (64% vs 21%, p < 0.001). Interestingly, they also had fewer follow up appointments, although this did not reach statistical significance (mean number of consultations of 2 versus 5 for those not trasplanted; p = 0.38). Table 1: Aetiology
n
Alcohol HCV NASH AIH/PBC/PSC Haemochromatosis/alpha-1antitrypsin deficiency Other
98 43 38 17 5 7
Table 2: Any EOLC WHO score 0 1 2 3 4 Total
Y
N
Total
90 39 6 2
27 25 14 4 1 71
117 64 20 6 1 208
137
Conclusions: A third of patients with cirrhosis seen in outpatient clinics in the Southwest of England meet at least one EOLC and are
Journal of Hepatology 2017 vol. 66 | S333–S542
S415
FRI-480 Systematic screening in an ongoing cross-sectional epidemiological study on hepatitis C high-risk populations in Trondheim city, Norway T. Svendsen1, M. Skaland1, S. Zinöcker2, R. Hannula1. 1Department of Infectious Diseases , St Olavs Hospital, Trondheim; 2AbbVie, Oslo, Norway E-mail: [email protected] Background and Aims: Globally, the morbidity and mortality attributable to hepatitis C virus (HCV) infection is increasing. The nature and magnitude of the hepatitis C epidemic is poorly described in most countries, including Norway. Reliable epidemiological data are essential when planning health programs for treatment and prevention, especially targeting persons who inject drugs (PWID) who are most at risk of becoming infected and infecting others. The main aim of this ongoing study is to assess the prevalence of HCV in high- risk populations. Methods: In this study, we implemented mobile, on-site HCV screening to reach at-risk populations in Trondheim, Norway. Inclusion started in September 2015. Two dedicated study nurses frequently visited the local opioid substitution clinic, outpatient clinics and day centres for PWID, as well as the local prison and refugee healthcare centre. Demographic data, risk behavior and clinical symptoms were obtained by a study questionnaire. Subjects with a positive anti-HCV rapid test we resubsequently tested for serum HCV RNA and the virus genotype d. Subjects with detectable HCV RNA were offered transient liver elastography using a mobile FibroScan402 unit. Results: Recruitment of PWID was time-consuming. Word-of-mouth within the targeted population seemed to impact recruitment. By November 2016, 304 people had been tested. 148 (41%) had a positive HCV rapid test result, and of these, 90 (73%) were also HCV RNA positive. 102 had been injecting drugs; for over 10 years, 4 were cirrhotic (≥12.5 kPa or higher). HCV genotypes 1a (29%) and 3 (59%) were most prevalent. Of 25 subjects previously treated, 8 had detectable HCV RNA (32%), 3 of these were likely reinfected. None of the 52 immigrants were HCV positive. 32 of the 62 subjects included while in prison had a history of intravenous drug use, and HCV prevalence was similar to PWID outside of prison. All except one person wished to be evaluated for treatment, however, many failed to keep follow-up appointments. Conclusions: PWID have a high prevalence of HCV, but only 17% of HCV positive PWID had previously been treated. 22 study participants should have been considered for treatment according to
Background and Aims: Liver disease is an increasing cause of death in England, yet end of life care is used infrequently in patients with cirrhosis. Our aim was to assess the prevalence of factors of poor prognosis and need for end of life care in patients with liver disease. Methods: Over 3 months, we assessed patients seen in our liver clinic for of any of 11 end of life criteria (EOLC), and assessed their WHO performance status. EOLC considered were hepatorenal syndrome, SBP/severe infection, encephalopathy (any of these within the last year), refractory ascites, Child Pugh class C, severe malnutrition, recurrent variceal bleeding, 2 or more non elective hospital admissions for liver disease, consideration for liver transplantation, hepatocellular carcinoma and ongoing alcohol intake despite previous decompensation/alcoholic hepatitis. Results: 650 individual patients were seen at 785 clinic appointments. 580 patients had liver disease and 208 (32%) had cirrhosis. Aetiology in Table 1. EOLC were present in 71 patients with cirrhosis (34%) (48 male, 23 female), but in only 8 patients without cirrhosis (2%). 36 patients with cirrhosis (17%) met more than 1 EOLC. The most commonly met EOLC were ongoing alcohol use (13%), two or more non elective admissions in the previous 6months (11%), severe malnutrition (8%) and encephalopathy (7%). WHO performance score was worse in patients who met EOLC (Table 2). In patients with liver disease but not cirrhosis the average WHO score was 0.15, in patients with cirrhosis without EOLC 0.42 and in patients with cirrhosis and EOLC 0.97. Patients with 4 or more EOLC were more likely to be considered for liver transplantation (64% vs 21%, p < 0.001). Interestingly, they also had fewer follow up appointments, although this did not reach statistical significance (mean number of consultations of 2 versus 5 for those not trasplanted; p = 0.38). Table 1: Aetiology
n
Alcohol HCV NASH AIH/PBC/PSC Haemochromatosis/alpha-1antitrypsin deficiency Other
98 43 38 17 5 7
Table 2: Any EOLC WHO score 0 1 2 3 4 Total
Y
N
Total
90 39 6 2
27 25 14 4 1 71
117 64 20 6 1 208
137
Conclusions: A third of patients with cirrhosis seen in outpatient clinics in the Southwest of England meet at least one EOLC and are
Journal of Hepatology 2017 vol. 66 | S333–S542
S415