T1974 Evidence for Considerable Undertreatment of Chronic Hepatitis C Infection in HIV-HCV Coinfected Patients

± 1.61; p=0.308) or inflammatory activity (smokers: 5.20 ± 2.25; non-smokers 5.80 ± 2.30; p=0.072). In smokers, no relevant correlation was found between number of pack years and degree of fibrosis (r=0.046; p=0.301). Portal inflammation was significantly more distinct in heavy (>15 pack years) smokers (1.93 ± 0.78 vs. 2.12 ± 0.82; p=0.033). Logistic regression analyses revealed that higher age (p=0.003; OR=1.04) and higher ALT (alanine transaminase) levels (p=0.001; OR=1.01) were independently associated with increased inflammatory activity. In contrast, the extent of liver fibrosis (cirrhosis vs. no cirrhosis) was significantly predicted only by the factor age (p< 0.001; OR=1.1), but not by other potential predictors such as nicotine and alcohol abuse. Conclusions: According to our findings, tobacco consumption seems to have at least some impact on the aggravation of inflammatory activity, while there was no influence on fibrosis progression. However, since nicotine abuse has been demonstrated to be a risk factor for the development of hepatocellular carcinoma, patients with HCV should be advised not to smoke.

T1974 Evidence for Considerable Undertreatment of Chronic Hepatitis C Infection in HIV-HCV Coinfected Patients Thomas Reiberger, Martin J. Obermeier, Berit A. Payer, Axel Baumgarten, Armin Rieger, Markus Peck-Radosavljevic Introduction: Hepatitis C virus (HCV) coinfection represents a significant factor of mortality and morbidity in HIV patients. According to current guidelines, treatment of chronic HCV infection should be considered as priority in HIV-HCV coinfected patients. Methods: This multicenter study includes HIV-HCV coinfected patients diagnosed since 2001 in 14 participating centers in Berlin, Hamburg and Vienna. Demographic data including HCV and HIV parameters were recorded. Factors associated with non-initiation of HCV treatment were identified. Results: 1033 HIV-HCV patients were included (m/f: 760/273; age: 43±9years; weight: 71±12kg; CD4+ nadir: 255±189/μL; HCV-RNA: 3.79xE6 IU/mL; HIV-RNA: 65xE3 copies/mL). 877 (85%) patients were german/austrian citizens, while 156 (15%) were foreign nationals/immigrants. HCV-genotypes (GT) were predominantly GT-1 (62%) and GT-3 (24%), followed by GT-4 (9%) and GT-2 (5%). Histological data were available for 146 patients with mean METAVIR fibrosis stage 3 (range: 1-4). 416 patients (40%) received HCV treatment, while 617 patients (60%) remained untreated. Main reasons for deferral of HCV treatment were patient wish (20%), adherence/compliance (19%), active IVDU (14%), comorbidities (9%), psychiatric illnesses (9%), advanced immunodeficiency/AIDS (9%), and others/unknown (22%). Patients starting HCV treatment had significantly lower fibrosis stage (F2 vs. F4, p<0.0001), higher actual CD4+ count (530/μL vs. 430/μL, p<0.0001), lower HIV-RNA levels (18E3 vs. 47E3 copies/mL, p=0.0008) and higher ALT (113 vs 75 IU/mL, p<0.0001) than patients without initiation of HCV treatment. Age, HCV-GT, HCV levels, hemoglobin levels, platelet count and white blood cell count did not significantly affect decision to initiate HCV treatment. Overall sustained virological response (SVR) rate was 51% (155/305), while patients with GT-1 and GT-3 achieved SVR rates of 38% and 75%, respectively. Conclusion: This large cohort study provides evidence for considerable undertreatment of chronic HCV infection in HIV patients. Despite acceptable treatment success in this real-life setting, HCV remains untreated in the majority of cases and often due to reason that should not be considered as absolute contraindications to antiviral therapy. Established predictors of treatment response, e.g. HCV-GT or HCV load did not influence treatment decision. Strategies to enhance adherence and medical advice for the HIV-HCV coinfected population are urgently needed.

T1972

AASLD Abstracts

Clinical Presentation of Chronic Hepatitis B (CHB) and C (CHC) and the Risks for Cirrhosis and/or Hepatic Decompensation (HD) and Hepatocellular Carcinoma (HCC) in Asian Americans Ali Abbasi, Calvin Pan, Victor W. Xia, Ke-Qin Hu BACKGROUND. Chronic liver diseases, including CHB and CHC are common in Asian Americans, but little is known on their clinical presentation in these patients. AIMS. To assess how CHB and CHC are presented and the risks for cirrhosis and/or HD, and HCC in this special population. METHODS. A single center retrospective study of a large cohort of patients followed in an academic liver clinic. RESULTS. The study assessed 363 Asian Americans (143 Vietnamese, 110 Chinese, 36 Korean, and 74 other Asians) with a mean 15.2 (3-60) months of follow-up. The mean age was 52.1 (17-83) years; 52.9% were males; 45.7% (n=166) had CHB and 32.5% (n=118) had CHC. Seventy-three cases (20.1%) presented with cirrhosis (i.e., liver biopsy report of stage 3-4 fibrosis, n=48) and/or HD (i.e., ascites or hepatic encephalopathy, n=25); 4.1%, with HCC. Patients with CHC presented with significantly higher rates of older age (≥ 60 years, 54.6% vs. 22.9%), history of diabetes mellitus (DM, 17.0% vs. 5.7%), elevated ALT (68.0% vs. 31.3%) and AST (63.9% vs. 26.5%); stage 3-4 fibrosis (42.6% vs. 23.2%), and HCC (14.8% vs. 1.8%) than those with CHB. The rates of hepatic steatosis (47.9% vs. 34.8%) and HD (5.1% vs. 3.6%) were not significantly different in both groups. Multivariate analyses indicated that cirrhosis and/or HD was independently associated with steatosis (p=0.04, OR=2.78), AST/ALT ratio ≥ 1 (p=0.02, OR=3.27), elevated serum alpha fetoprotein (AFP, p=0.03, OR=3.47); and HCC was independently associated with age of ≥ 60 years (p=0.04, OR=3.26), HCV infection (p=0.04, OR=4.01), and elevated AFP (p=0.001, OR=4.52). CONCLUSIONS. In this cohort of Asian American patients, CHC was more associated with older age, history of DM, elevated ALT and AST, stage 3-4 fibrosis, and HCC; cirrhosis was independently associated with steatosis, AST/ALT ratio, and serum AFP; and HCC, with age of ≥ 60 years , HCV infection, and serum AFP elevation.

T1975 Simple Outpatient Reminders Increase Screening for HIV, but Not Hepatitis A and B Vaccination in Hepatitis C Infection David R. Moore, Clark C. Kulig, Robert H. Harris, Angela Keniston, Nancy G. Boyd Purpose: The Centers for Disease Control recommends that patients in all health care settings be screened for HIV and all patients with chronic hepatitis C virus (HCV) be screened and vaccinated for hepatitis A and B (hep A&B) if they are not immune. The purpose of this study is to assess whether interventions improved providers' adherence to these guidelines. Methods: The pre-intervention (control) group was comprised of adult patients referred to clinic for HCV management in 2007. Interventions were implemented for patients referred to the same clinics the following year. These included an HIV/hep A&B screening and vaccination recommendation sheet for gastroenterologists at a county hospital and an electronic screening/vaccination recommendation prompt for primary care providers (PCPs) at a VA hospital. The primary outcome is percentage of patients who were assessed for HIV status. Secondary outcomes include changes in hep A&B screening and vaccination for those not immune. Statistical analysis was performed using either chi-square testing or Fisher's exact test. Results: County hospital: HIV check rates rose from 49% to 67% (p<0.001) postintervention and HBsAb screen rates increased from 24% to 59% (p<0.0001). However, Hep A Ab screening decreased from 67% to 54% (p<0.006) and there were no significant changes in hep A&B vaccination rates (24% to 35% and 33% to 42%, respectively). VA hospital: HIV screen rates rose from 41% to 80% (p<0.0001) post-intervention. However, there was no significant change in screening for Hep A Ab or HBsAb (88% to 96% and 93% to 96%, respectively), or hep A&B vaccination rates (72% to 66% and 52% to 62%, respectively). Conclusions: Clinical interventions aimed at both PCPs and gastroenterologists improved HIV screen rates, but did not improve vaccination rates for hep A&B. Gastroenterology-directed interventions increased HBsAb screening but decreased Hep A Ab screening, whereas PCP-directed interventions had no significant change in hep A&B screening. An intervention more involved than a simple prompt may be required to impact hep A&B vaccinations.

T1973 Gender Disparity and Risk Factors for Hepatocellular Carcinoma in Hospitalized Patients in the United States in 2006 Florence Aslinia, Nicholas A. Tilton, Charles D. Howell Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the US. Although the incidence of HCC is 3-5 times lower in females than males, the incidence of the disease has been rising in both genders over the past 2 decades. The aim of the study was to compare the risk factors for HCC among the hospitalized males and females in the US in 2006. Methods: We analyzed 5893 adult hospitalizations with HCC (ICD-9: 155.00) in the Nationwide Inpatient Sample (NIS) Database from 2006. Risk factors for HCC were categorized as hepatitis C infection (HCV), hepatitis B infection (HBV), alcoholic liver disease (ALD), diabetes mellitus (DM), cryptogenic cirrhosis and other chronic liver diseases. Discrete and continuous variables were compared between males and females using Chi-square and t-tests. Results: 27% of HCC cases (1582) in the NIS 2006 were females, of which 37.2% were Caucasians, 11.9% African-Americans, 17.0% Hispanics, 7.3% Asians, 0.3% Native-Americans and 2.5% “other races”. The females were older than males (mean age 66.3 vs. 61.5 years, p<0.0001). The most common risk factors for HCC in females was DM, followed by HCV, cryptogenic cirrhosis, ALD, HBV and other chronic liver diseases. HCV was the most common risk factor in males followed by DM, ALD, cryptogenic cirrhosis, and HBV. HCV, HBV and ALD were more common among male than females cases (P <0.0001), whereas females cases were more likely to have other chronic liver diseases (p=0.0002) and not identified HCC risk factor (p=0.0001). There was no gender difference in the prevalence of DM. However, among HCC patients without an identified risk factor, DM was more common among females (19.3 vs.14.2%, p<0.0001). Males were more likely to have two or more risk factors for HCC than females. Conclusion: In 2006, risk factors for HCC in the US varied by gender, but together HCV and DM were risk factors for more than 50% of HCC cases in both sexes. Risk factors for HCC in 2006 NIS

T1976 Defining the Etiology in Patients Referred for Elevated Serum Aminotransferases in an Urban Community Johnny Altawil, Fadi Matta, Firdous A. Siddiqui Background: Etiologies of abnormal serum aminotransferases (ALT and AST) values differ between communities depending on level of education, type of diet, risk of infections, and adequacy of medical care and follow up. Aim: To determine the most common etiologies for elevated serum aminotransferases in an urban community. Methods: A retrospective analysis of medical records of 218 patients referred to Detroit Medical Center GI outpatient clinic between January 1st 2004 and June 30th 2008 for elevated serum (ALT and/or AST >40). Patients were between 18 and 88 years old and had no decompensated liver disease. Chi-Square was used to assess differences of proportions between diagnosis, age, race and gender. Results: Among 218 patients with ALT and/or AST elevation, 55% were males, mean age was 48 + 12 years, 162(74%) patients were African American (AA), 22 (10%) patients were White, 7 (3%) patients were Hispanic, and 27 (12%) patients were Asians. The proportion of patients with their final diagnosis are shown in (Figure 1) Chronic hepatitis C (CHC) was the most frequent diagnosis in AA patients [(64/162 (40%)] followed by NAFLD [27/162 (17%)], alcoholic liver disease [24/162 (15%)], and drug induced liver

* p<0.001 female compared to male

AASLD Abstracts

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