- Email: [email protected]
T is Associated with Major Depressive Disorder in Patients with Chronic Hepatitis C
POSTER PRESENTATIONS 43%) than males ( p < 0.05). Genotype (Gt) 1 (70% and 64%) and 2 (20% and 14%) were more prevalent in females compared to Gt 3 (15% vs 7%) and 4 (10% vs 3%) which were more prevalent in males. F0-F1 fibrosis stage was significantly more prevalent in females (59%) vs males (33%). Sixty-six% of females and 44% of males younger than 50 years had F0-F1 fibrosis. F4/cirrhosis was significantly higher in males (39%) vs females (28%)(p < 0.05). In males F4/cirrhosis was present in 30% and 43% of those younger and older than 50 years of age respectively and in females in 11% vs. 30% respectively reaching the same distribution after 60 years (Figure 1). In females ALTs were significantly higher ( p < 0.001) in each fibrosis stage whereas the prevalence of HIV and HBsAg coinfections were significantly lower (4% vs 8% p < 0.05 and 1% vs 2% respectively). 46% of females were previously treated with IFN-based therapy compared to 63% of males. Of those treated 40% of females and 27% of males ( p < 0.05) had F0-F1 fibrosis whereas 34% of female vs. 44% of males had F4 /cirrhosis. Hypertension (28% vs 20%), osteoarticular diseases (10.4% vs 3.1%) and tumours (7.1 vs 3.6%) were significantly higher in females. Male gender, increased BMI, previous alcohol use, genotype 3 and diabetes were independently associated with cirrhosis by logistic regression analysis.
Conclusions: In this large cohort of Italian patients, female gender was not indipendently associated to cirrhosis. Females younger than 50 years had significantly lower fibrosis compared to men, however risk of cirrhosis in females increased significantly in women older than 60 years. DAA therapies should therefore be made available to females before occurence of menopause considering the high rate of cirrhosis in women older than 60 years of age. FRI-181 HCV–RELATED MIXED CRYOGLOBULINEMIA: DATA FROM PITER, A NATIONWIDE ITALIAN HCV COHORT STUDY L. Kondili1, L.E. Weimer1, A. Mallano1, L. Fucili1, M. Massella1, M. Vinci2, G. Borgia3, M. Brunetto4, L. Surace4, G.B. Gaeta5, L. Chemello6, P. Andreone7, G. Raimondo8, R. Filomia8, M. Persico9, M. Puoti10, M.G. Rumi11, A. Benedetti12, S. Fargion13, D. Ieluzzi14, G. Nardone3, F. Giuseppe15, A. Ciancio16, G. Taliani17, E. Biliotti17, S. Madonia18, B. Stagno18, A. Alberti19, M. Massari20, F. Rosina21, G. Mazzella22, A. Di Leo23, A. Iannone23, C. Ferrari24, A. Orlandini24, M. Monti25, T.A. Santantonio26, L. Chessa27, E.M. Erne19, C. Coppola28, M. Andreoni29, F. Baldelli30, M. Mondelli31, P. Blanc32, A. Gasbarrini33, G. Verucchi34, M. Colombo35, M. Borghi36, A. Craxì37, S. Petta37, E. Villa38, O. Patti38, F.P. Russo19, M. Strazzabosco39, S. Vella1, A.L. Zignego25. 1Istituto Superiore di Sanità, Roma; 2Ospedale Niguarda, Milano; 3Università Federico II, Napoli; 4AOU Pisana, Pisa; 5Seconda Università degli Studi, Napoli; 6Università di Padova, Padova; 7Policlinico Sant’Orsola Malpighi, Bologna; 8AOU Policlinico, Messina; 9Ospedale G. da Procida, Salerno; 10AO Niguarda-Cà Granda; 11UO San Giuseppe, Milano; 12Università Politecnica delle Marche, Ancona; 13Fondazione IRCCS Ca’ Granda, Milano; 14AOU Verona, Verona; 15AO “Bianchi Malacrino-Morelli”, Reggio Calabria; 16Ospedale Molinette, Torino; 17 Policlinico Umberto I, Roma; 18Ospedale Cervello, Palermo; 19AO Padova, Padova; 20ASMN Reggio Emilia, Reggio Emilia; 21Presidio
Sanitario Gradenigo, Torino; 22Ospedale Sant’Orsola Malpighi, Bologna; 23 AO Policlinico, Bari; 24AOU Parma, Parma; 25AOU Careggi, Firenze; 26 Ospedali Riuniti, Foggia; 27AOU Cagliari, Cagliari; 28Ospedale di Gragnano, Napoli; 29Policlinico Universitario Tor Vergata, Roma; 30 Policlinico S. Maria della Misericordia, Perugia; 31Policlinico San Matteo, Pavia; 32Ospedale S.Maria Annunziata, Firenze; 33Policlinico Gemelli, Roma; 34Ospedale Sant’ Orsola Malpighi, Bologna; 35 Fondazione IRCCS Ospedale Maggiore Policlinico; 36Fondazione IRCCS Ospedale Maggiore Policlinico, Milano; 37Policlinico Giaccone, Palermo; 38 Università di Modena, Modena; 39AO San Gerardo, Monza, Italy E-mail: [email protected] Background and Aims: HCV is the etiologic agent for the great majority of patients with mixed cryoglobulinemia (MC), however data regarding the large scale prevalence of this disorder are limited. The aim of this study was to evaluate the prevalence and the clinical profile of MC in patients enrolled in a real-life cohort of 7496 consecutive patients presenting for care at 80 Italian Units, collected over the last 12 months within the PITER framework. Methods: A specific questionnaire regarding the presence of crioglobulinemia and related symptoms was applied. MC was characterised at baseline according to the fibrosis stage and to the treatment history. Results: Of 7496 patients enrolled, the MC was never tested in 6019 (80%). The remaining 1477 HCV(+) patients were classified as follows: in 22% as symptomatic MC (MCS-HCV:mean age 64 + −11 years), in 29% as asymptomatic MC (MC-HCV: mean age 61 + −12 years), and in 49% as HCV infected patients without MC (mean age 60 + −13 years). Among the 328 patients declared to be “symptomatic”, detailed data that confirmed MCS were available for 252 (33% of patients with MC). MC symptoms included purpura, weakness, and arthralgia (MC triad), as well as peripheral neuropathy, sicca syndrome, myalgias, cutaneous ulcers and renal involvement. History of nocturnal sweet, fever and pruritis was also rarely reported. In patients with MCS the liver fibrosis stage, was F0-F1 in 40%; F2 in 12%; F3 in 13% and F4 in 35% of patients, with no significant differences among the different groups ( p > 0.5). Previous IFN-based therapy was reported in 54% of MCS-HCV, in 45% of MC-HCV and in 50% of HCV patients. 162 (65%) of MCS-HCV patients have been treated or are on treatment with DAA (in combination with immunosuppressants in 10% of cases). Only preliminary results of DAA’s treatment are available showing high rate of virological and clinical response with rare (1%: 3 patients) treatment interruption due to adverse events/intolerance. Conclusions: This nation-wide, in progress study showed that, in spite of the clinical and therapeutic importance of HCV-related MC ( patients with clinically significant MC have been considered as prioritized group of treatment), the presence of this condition was not considered in the large majority of cases. Among patients with MC, a symptomatic form was observed in more than 30% of cases. Treated patients will be prospectively followed up to better characterize and define the long term outcome of such an important consequence of chronic HCV infection. FRI-182 THE IL10-819C/T IS ASSOCIATED WITH MAJOR DEPRESSIVE DISORDER IN PATIENTS WITH CHRONIC HEPATITIS C L.R. Cunha1, D.A. Vieira1, Y.G. Giampietro1, A.D. Gomes2, C. Faria, Jr 2, R. Teixeira1,3, O.A. Martins Filho4, F.S. Neves5, G.A. Rocha2, D.M. Queiroz2, L.D. Silva3,6. 1Viral Hepatitis Ambulatory, Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais; 2Laboratory of Research in Bacteriology; 3Internal Medicine, Faculdade De Medicina Da Universidade Federal De Minas Gerais; 4Diagnoses and Monitoring Biomarkers Laboratory, Instituto René Rachou, Fundação Oswaldo Cruz; 5Mental Health, Faculdade de Medicina da Universidade Federal de Minas Gerais; 6Viral Hepatitis Ambulatory, Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil E-mail: [email protected]
Journal of Hepatology 2016 vol. 64 | S425–S630
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POSTER PRESENTATIONS Background and Aims: Depressive disorder has high prevalence in chronic hepatitis C (CHC), however the pathophysiology of HCVrelated neuropsychiatric symptoms remains poorly understood. Both CHC and major depressive disorder (MDD) have been associated with increased levels of pro-inflammatory cytokines. Single nucleotide polymorphism (SNP) can affect inflammation and immune regulation and, as consequence, the development of illness. Therefore, we aimed to investigate whether IL6-174G/C and IL10819C/T polymorphisms are associated with MDD in patients with CHC. Since these polymorphisms are functional, further we aimed to test whether significant associations in the first analysis had relevance in plasma levels of target cytokines. Methods: 139 consecutive CHC patients (46 with MDD and 93 without MDD) were prospectively enrolled. MDD was diagnosed by using Mini-International Neuropsychiatry Interview, Hamilton Depression Rating Scale and Hospital Anxiety and Depression Scale. Clinical, laboratory and sociodemographic variables were evaluated in CHC patients with and without MDD. Cytokine genotyping was carried out by PCR. Plasma cytokine levels ( pg/mL) were measured by Cytometric Bead Array method. The study was approved by Ethics Committee of UFMG. Results: In multivariate analysis, previous history of MDD (OR = 2.96; CI95% 1.08-8.10; p = 0.03), diabetes mellitus (OR = 2.77; CI95% 1.037.47; p = 0.04), IL10-819C/T polymorphism (OR = 2.45 CI95% 1.065.69; p = 0.04) were associated with current MDD. IL6-174G/C ( p = 0.27) and IL10-819C/T ( p = 1) were in Hardy Weinberg equilibrium. In the group of patients with current MDD, IL10-819*T carriers [median (IQR) 4.1 (0.6) vs. 3.9 (0.5), p = 0.04] had significant higher plasma levels of TNF-α than IL10-819*C carriers. Although IL6-174G/C was not associated with MDD, IL6-174*C carriers had significant lower plasma levels [median (IQR) 3.7 (0.7) vs. 4.0 (0.5), p = 0.01) of IL-4 than IL6174*G carriers. Conclusions: This is the first study to show that IL10-819C/T carrier is associated with MDD in patients with CHC. We also demonstrated that the polymorphism interfere with plasma levels of TNF-α. FRI-183 THE PRESENCE OF DIABETES MELLITUS IS A STRONG RISK FACTOR FOR HEPATOCELLULAR CARCINOMA IN HEPATITIS C INFECTED PATIENTS WITH ADVANCED FIBROSIS OR CIRRHOSIS WHO HAVE ACHIEVED SUSTAINED VIROLOGICAL RESPONSE M. Hedenstierna1,2, A. Nangarhari1, O. Weiland1,3, S. Aleman1,3,4. 1 Department of Medicine, Karolinska Institutet; 2Department of Infectious Diseases, Danderyd Hospital; 3Department of Infectious Diseases; 4Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden E-mail: [email protected] Background and Aims: Successful treatment of hepatitis C infection reduces the risk for hepatocellular carcinoma (HCC), but a risk persists and current guidelines recommend continued surveillance with ultrasound for high risk groups also after sustained virological response (SVR). We aimed to investigate risk-factors and incidence rates for HCC after SVR in patients with pre-treatment cirrhosis or advanced fibrosis. Methods: All patients with pre-treatment advanced fibrosis or cirrhosis successfully treated for chronic hepatitis C infection at Karolinska University Hospital 1992-2013 (n = 399), were followed a median of 7.8 years (total follow-up time of 3366 person-years). 180 patients (45 %) had pre-treatment cirrhosis. Data from Swedish National Registries were used to minimize loss to follow-up. Hazard ratios for HCC were calculated by Cox regression for baseline variables and risk over time was investigated by the Kaplan-Meier method and by calculation of incidence rates. Results: During follow-up, 17 patients developed HCC. Multivariate Cox regression showed a hazard ratio of 6.3 (95% CI 1.7-23) for diabetes mellitus. The incidence rate for HCC was 0.15/100 personyears (95 % CI 0.05-0.49) and 0.95 (95 % CI 0.57-1.6) for patients with S620
METAVIR F3 and F4 respectively. Patients with pre-treatment cirrhosis and baseline DM had an incidence rate of 3.6/100 personyears (95 % CI 1.8–7.2) for the whole follow-up period, and an incidence rate of 7.0/100 person-years (95 % CI 3.1–15.5) and 1.5/100 person-years (95 % CI 0.36–5.8) before and after three years of followup respectively. Conclusions: Diabetes mellitus continues to be an important risk factor for HCC development after SVR has been reached in patients with cirrhosis prior to treatment. Hence, the HCC incidence rate for this patient category is very high during the first three years after SVR. Patients with pre-treatment advanced fibrosis without cirrhosis on the other hand had a low incidence of HCC after having achieved SVR and the benefit of surveillance in this group is questionable.
FRI-184 INCIDENCE OF HCV REINFECTION AMONG TREATED INDIVIDUALS WITH RECENTLY ACQUIRED INFECTION M. Martinello1, K. Petoumenos1, J. Grebely1, Ed Gane2, M. Hellard3–5, D. Shaw6, J. Sasdeusz7, T. Applegate1, F. Lamoury1, B. Yeung1, L. Maire1, G. Dore1,8, G. Matthews1,8. 1Kirby Institute, UNSW Australia, Sydney, Australia; 2Auckland City Hospital, Auckland, New Zealand; 3Burnet Institute; 4Infectious Diseases Unit, Alfred Hospital; 5Department of Epidemiology and Preventative Medicine, Monash University, Melbourne; 6Royal Adelaide Hospital, Adelaide; 7Royal Melbourne Hospital, Melbourne; 8St Vincent’s Hospital, Sydney, Australia E-mail: [email protected] Background and Aims: HCV reinfection may compromise treatment outcome in some populations. The aim of this analysis was to investigate the epidemiological, virological and clinical characteristics of reinfection among individuals treated for recent HCV infection. Methods: Individuals with recent primary HCV (duration of infection <24 months) who received treatment in three prospective open-label studies (ATAHC II, DARE-C I, DARE-C II) in Australia and New Zealand were assessed for reinfection. Reinfection was defined by detection of infection with an HCV strain distinct from the primary strain (sequencing of CoreE2 and/or NS5B regions) following viral suppression (undetectable HCV RNA at end of treatment). In the at-risk cohort (viral suppression without relapse), reinfection incidence rate was calculated using person-time of observation with time at-risk calculated from end of treatment until HCV RNA recurrence or last undetectable HCV RNA during follow-up. Factors associated with reinfection were assessed using exact Poisson regression analysis. Results: Of 115 enrolled, 84 treated individuals were suitable for initial analysis (30 untreated; one lost to follow up at end of treatment). HCV viral suppression occurred in 71 (85%) with
Journal of Hepatology 2016 vol. 64 | S425–S630
Conclusions: In this large cohort of Italian patients, female gender was not indipendently associated to cirrhosis. Females younger than 50 years had significantly lower fibrosis compared to men, however risk of cirrhosis in females increased significantly in women older than 60 years. DAA therapies should therefore be made available to females before occurence of menopause considering the high rate of cirrhosis in women older than 60 years of age. FRI-181 HCV–RELATED MIXED CRYOGLOBULINEMIA: DATA FROM PITER, A NATIONWIDE ITALIAN HCV COHORT STUDY L. Kondili1, L.E. Weimer1, A. Mallano1, L. Fucili1, M. Massella1, M. Vinci2, G. Borgia3, M. Brunetto4, L. Surace4, G.B. Gaeta5, L. Chemello6, P. Andreone7, G. Raimondo8, R. Filomia8, M. Persico9, M. Puoti10, M.G. Rumi11, A. Benedetti12, S. Fargion13, D. Ieluzzi14, G. Nardone3, F. Giuseppe15, A. Ciancio16, G. Taliani17, E. Biliotti17, S. Madonia18, B. Stagno18, A. Alberti19, M. Massari20, F. Rosina21, G. Mazzella22, A. Di Leo23, A. Iannone23, C. Ferrari24, A. Orlandini24, M. Monti25, T.A. Santantonio26, L. Chessa27, E.M. Erne19, C. Coppola28, M. Andreoni29, F. Baldelli30, M. Mondelli31, P. Blanc32, A. Gasbarrini33, G. Verucchi34, M. Colombo35, M. Borghi36, A. Craxì37, S. Petta37, E. Villa38, O. Patti38, F.P. Russo19, M. Strazzabosco39, S. Vella1, A.L. Zignego25. 1Istituto Superiore di Sanità, Roma; 2Ospedale Niguarda, Milano; 3Università Federico II, Napoli; 4AOU Pisana, Pisa; 5Seconda Università degli Studi, Napoli; 6Università di Padova, Padova; 7Policlinico Sant’Orsola Malpighi, Bologna; 8AOU Policlinico, Messina; 9Ospedale G. da Procida, Salerno; 10AO Niguarda-Cà Granda; 11UO San Giuseppe, Milano; 12Università Politecnica delle Marche, Ancona; 13Fondazione IRCCS Ca’ Granda, Milano; 14AOU Verona, Verona; 15AO “Bianchi Malacrino-Morelli”, Reggio Calabria; 16Ospedale Molinette, Torino; 17 Policlinico Umberto I, Roma; 18Ospedale Cervello, Palermo; 19AO Padova, Padova; 20ASMN Reggio Emilia, Reggio Emilia; 21Presidio
Sanitario Gradenigo, Torino; 22Ospedale Sant’Orsola Malpighi, Bologna; 23 AO Policlinico, Bari; 24AOU Parma, Parma; 25AOU Careggi, Firenze; 26 Ospedali Riuniti, Foggia; 27AOU Cagliari, Cagliari; 28Ospedale di Gragnano, Napoli; 29Policlinico Universitario Tor Vergata, Roma; 30 Policlinico S. Maria della Misericordia, Perugia; 31Policlinico San Matteo, Pavia; 32Ospedale S.Maria Annunziata, Firenze; 33Policlinico Gemelli, Roma; 34Ospedale Sant’ Orsola Malpighi, Bologna; 35 Fondazione IRCCS Ospedale Maggiore Policlinico; 36Fondazione IRCCS Ospedale Maggiore Policlinico, Milano; 37Policlinico Giaccone, Palermo; 38 Università di Modena, Modena; 39AO San Gerardo, Monza, Italy E-mail: [email protected] Background and Aims: HCV is the etiologic agent for the great majority of patients with mixed cryoglobulinemia (MC), however data regarding the large scale prevalence of this disorder are limited. The aim of this study was to evaluate the prevalence and the clinical profile of MC in patients enrolled in a real-life cohort of 7496 consecutive patients presenting for care at 80 Italian Units, collected over the last 12 months within the PITER framework. Methods: A specific questionnaire regarding the presence of crioglobulinemia and related symptoms was applied. MC was characterised at baseline according to the fibrosis stage and to the treatment history. Results: Of 7496 patients enrolled, the MC was never tested in 6019 (80%). The remaining 1477 HCV(+) patients were classified as follows: in 22% as symptomatic MC (MCS-HCV:mean age 64 + −11 years), in 29% as asymptomatic MC (MC-HCV: mean age 61 + −12 years), and in 49% as HCV infected patients without MC (mean age 60 + −13 years). Among the 328 patients declared to be “symptomatic”, detailed data that confirmed MCS were available for 252 (33% of patients with MC). MC symptoms included purpura, weakness, and arthralgia (MC triad), as well as peripheral neuropathy, sicca syndrome, myalgias, cutaneous ulcers and renal involvement. History of nocturnal sweet, fever and pruritis was also rarely reported. In patients with MCS the liver fibrosis stage, was F0-F1 in 40%; F2 in 12%; F3 in 13% and F4 in 35% of patients, with no significant differences among the different groups ( p > 0.5). Previous IFN-based therapy was reported in 54% of MCS-HCV, in 45% of MC-HCV and in 50% of HCV patients. 162 (65%) of MCS-HCV patients have been treated or are on treatment with DAA (in combination with immunosuppressants in 10% of cases). Only preliminary results of DAA’s treatment are available showing high rate of virological and clinical response with rare (1%: 3 patients) treatment interruption due to adverse events/intolerance. Conclusions: This nation-wide, in progress study showed that, in spite of the clinical and therapeutic importance of HCV-related MC ( patients with clinically significant MC have been considered as prioritized group of treatment), the presence of this condition was not considered in the large majority of cases. Among patients with MC, a symptomatic form was observed in more than 30% of cases. Treated patients will be prospectively followed up to better characterize and define the long term outcome of such an important consequence of chronic HCV infection. FRI-182 THE IL10-819C/T IS ASSOCIATED WITH MAJOR DEPRESSIVE DISORDER IN PATIENTS WITH CHRONIC HEPATITIS C L.R. Cunha1, D.A. Vieira1, Y.G. Giampietro1, A.D. Gomes2, C. Faria, Jr 2, R. Teixeira1,3, O.A. Martins Filho4, F.S. Neves5, G.A. Rocha2, D.M. Queiroz2, L.D. Silva3,6. 1Viral Hepatitis Ambulatory, Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais; 2Laboratory of Research in Bacteriology; 3Internal Medicine, Faculdade De Medicina Da Universidade Federal De Minas Gerais; 4Diagnoses and Monitoring Biomarkers Laboratory, Instituto René Rachou, Fundação Oswaldo Cruz; 5Mental Health, Faculdade de Medicina da Universidade Federal de Minas Gerais; 6Viral Hepatitis Ambulatory, Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil E-mail: [email protected]
Journal of Hepatology 2016 vol. 64 | S425–S630
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POSTER PRESENTATIONS Background and Aims: Depressive disorder has high prevalence in chronic hepatitis C (CHC), however the pathophysiology of HCVrelated neuropsychiatric symptoms remains poorly understood. Both CHC and major depressive disorder (MDD) have been associated with increased levels of pro-inflammatory cytokines. Single nucleotide polymorphism (SNP) can affect inflammation and immune regulation and, as consequence, the development of illness. Therefore, we aimed to investigate whether IL6-174G/C and IL10819C/T polymorphisms are associated with MDD in patients with CHC. Since these polymorphisms are functional, further we aimed to test whether significant associations in the first analysis had relevance in plasma levels of target cytokines. Methods: 139 consecutive CHC patients (46 with MDD and 93 without MDD) were prospectively enrolled. MDD was diagnosed by using Mini-International Neuropsychiatry Interview, Hamilton Depression Rating Scale and Hospital Anxiety and Depression Scale. Clinical, laboratory and sociodemographic variables were evaluated in CHC patients with and without MDD. Cytokine genotyping was carried out by PCR. Plasma cytokine levels ( pg/mL) were measured by Cytometric Bead Array method. The study was approved by Ethics Committee of UFMG. Results: In multivariate analysis, previous history of MDD (OR = 2.96; CI95% 1.08-8.10; p = 0.03), diabetes mellitus (OR = 2.77; CI95% 1.037.47; p = 0.04), IL10-819C/T polymorphism (OR = 2.45 CI95% 1.065.69; p = 0.04) were associated with current MDD. IL6-174G/C ( p = 0.27) and IL10-819C/T ( p = 1) were in Hardy Weinberg equilibrium. In the group of patients with current MDD, IL10-819*T carriers [median (IQR) 4.1 (0.6) vs. 3.9 (0.5), p = 0.04] had significant higher plasma levels of TNF-α than IL10-819*C carriers. Although IL6-174G/C was not associated with MDD, IL6-174*C carriers had significant lower plasma levels [median (IQR) 3.7 (0.7) vs. 4.0 (0.5), p = 0.01) of IL-4 than IL6174*G carriers. Conclusions: This is the first study to show that IL10-819C/T carrier is associated with MDD in patients with CHC. We also demonstrated that the polymorphism interfere with plasma levels of TNF-α. FRI-183 THE PRESENCE OF DIABETES MELLITUS IS A STRONG RISK FACTOR FOR HEPATOCELLULAR CARCINOMA IN HEPATITIS C INFECTED PATIENTS WITH ADVANCED FIBROSIS OR CIRRHOSIS WHO HAVE ACHIEVED SUSTAINED VIROLOGICAL RESPONSE M. Hedenstierna1,2, A. Nangarhari1, O. Weiland1,3, S. Aleman1,3,4. 1 Department of Medicine, Karolinska Institutet; 2Department of Infectious Diseases, Danderyd Hospital; 3Department of Infectious Diseases; 4Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden E-mail: [email protected] Background and Aims: Successful treatment of hepatitis C infection reduces the risk for hepatocellular carcinoma (HCC), but a risk persists and current guidelines recommend continued surveillance with ultrasound for high risk groups also after sustained virological response (SVR). We aimed to investigate risk-factors and incidence rates for HCC after SVR in patients with pre-treatment cirrhosis or advanced fibrosis. Methods: All patients with pre-treatment advanced fibrosis or cirrhosis successfully treated for chronic hepatitis C infection at Karolinska University Hospital 1992-2013 (n = 399), were followed a median of 7.8 years (total follow-up time of 3366 person-years). 180 patients (45 %) had pre-treatment cirrhosis. Data from Swedish National Registries were used to minimize loss to follow-up. Hazard ratios for HCC were calculated by Cox regression for baseline variables and risk over time was investigated by the Kaplan-Meier method and by calculation of incidence rates. Results: During follow-up, 17 patients developed HCC. Multivariate Cox regression showed a hazard ratio of 6.3 (95% CI 1.7-23) for diabetes mellitus. The incidence rate for HCC was 0.15/100 personyears (95 % CI 0.05-0.49) and 0.95 (95 % CI 0.57-1.6) for patients with S620
METAVIR F3 and F4 respectively. Patients with pre-treatment cirrhosis and baseline DM had an incidence rate of 3.6/100 personyears (95 % CI 1.8–7.2) for the whole follow-up period, and an incidence rate of 7.0/100 person-years (95 % CI 3.1–15.5) and 1.5/100 person-years (95 % CI 0.36–5.8) before and after three years of followup respectively. Conclusions: Diabetes mellitus continues to be an important risk factor for HCC development after SVR has been reached in patients with cirrhosis prior to treatment. Hence, the HCC incidence rate for this patient category is very high during the first three years after SVR. Patients with pre-treatment advanced fibrosis without cirrhosis on the other hand had a low incidence of HCC after having achieved SVR and the benefit of surveillance in this group is questionable.
FRI-184 INCIDENCE OF HCV REINFECTION AMONG TREATED INDIVIDUALS WITH RECENTLY ACQUIRED INFECTION M. Martinello1, K. Petoumenos1, J. Grebely1, Ed Gane2, M. Hellard3–5, D. Shaw6, J. Sasdeusz7, T. Applegate1, F. Lamoury1, B. Yeung1, L. Maire1, G. Dore1,8, G. Matthews1,8. 1Kirby Institute, UNSW Australia, Sydney, Australia; 2Auckland City Hospital, Auckland, New Zealand; 3Burnet Institute; 4Infectious Diseases Unit, Alfred Hospital; 5Department of Epidemiology and Preventative Medicine, Monash University, Melbourne; 6Royal Adelaide Hospital, Adelaide; 7Royal Melbourne Hospital, Melbourne; 8St Vincent’s Hospital, Sydney, Australia E-mail: [email protected] Background and Aims: HCV reinfection may compromise treatment outcome in some populations. The aim of this analysis was to investigate the epidemiological, virological and clinical characteristics of reinfection among individuals treated for recent HCV infection. Methods: Individuals with recent primary HCV (duration of infection <24 months) who received treatment in three prospective open-label studies (ATAHC II, DARE-C I, DARE-C II) in Australia and New Zealand were assessed for reinfection. Reinfection was defined by detection of infection with an HCV strain distinct from the primary strain (sequencing of CoreE2 and/or NS5B regions) following viral suppression (undetectable HCV RNA at end of treatment). In the at-risk cohort (viral suppression without relapse), reinfection incidence rate was calculated using person-time of observation with time at-risk calculated from end of treatment until HCV RNA recurrence or last undetectable HCV RNA during follow-up. Factors associated with reinfection were assessed using exact Poisson regression analysis. Results: Of 115 enrolled, 84 treated individuals were suitable for initial analysis (30 untreated; one lost to follow up at end of treatment). HCV viral suppression occurred in 71 (85%) with
Journal of Hepatology 2016 vol. 64 | S425–S630