Sa1075 Hepatitis C in the Amazon Rainforest
1
AASLD Abstracts biopsy - Table 1. One patient was deemed cirrhotic radiologically and not biopsied. The remaining 3/9 patients were not biopsied because of the bleeding risks. 8/9 (7M, 1F) HCV PCR +ve patients were treated with pegaylatedIFN/Ribavirin. 6/8 ( 2/4 G1, 3 G3.,1 G4) - 75% -achieved SVR at 6 months and were deemed cured of HCV. 1 M (G1a) was a responder- relapser and 1M (G1a) was a null responder. There were no unexpected complications during treatment. CONCLUSION: We have shown that few patients (3.6%) with bleeding disorders have been infected with HCV despite repeated blood product infusions. There is a high cure rate and no patient required a liver transplant. As expected, genotype 1 was the commonest genotype in this cohort. All of our patients have had governmental compensa- tion from the Skipton Fund(1). Ref1:www.skiptonfund.org Liver Biopsy Details-Table 1 Stage and grade of HCV infection in 4/11 patients infected with HCV during treatment for bleeding disorders. Sa1073 Emerging Understanding of the Oncogenic Potential of Hepatitis C Virus Infection and the Association With Renal Cell Carcinoma Mark Cahill, Jessica Burke, Bradford Waters Purpose of Study: We aim to further elucidate the emerging association between renal cell carcinoma (RCC) and hepatitis C virus (HCV). Methods Used: With institutional review board approval, we obtained a list of all RCC diagnoses made at the Memphis Veteran Affairs Medical Center (VAMC) from 2002-2012. We then performed a retrospective chart review of these patients. We also reviewed the national VA Hepatitis C registry. Summary of Results: As of 2011, the number of veterans in the US who have ever had HCV viremia is 170,119. Of all US veterans with HCV viremia, 1,250 (0.7%) have ever been diagnosed with RCC. At the Memphis VAMC, there have been 180 biopsy-proven diagnoses of RCC from 2002-2012. Of these patients, 140 (78%) have been tested for HCV infection. Among those tested for HCV infection, 27 (19%) had antibody seropositivity. Among the 27 HCV seropositive patients, 19 (70%) were viremic, 5 (19%) had an undectable viral load, and 3 (11%) were never tested for HCV viremia. Presuming the 40 RCC patients who were never tested for HCV infection were indeed HCV negative, the prevalence of past or current HCV infection among RCC patients is 15% (27 of 180 cases). Among the 27 HCV seropositive patients, the average age at diagnosis of RCC was 57 (range, 45-77), 100% were male, 59% were African American, 85% were tobacco abusers, 33% were obese, 11% had ESRD requiring hemodialysis prior to RCC diagnosis, 89% had hypertension, and 30% had diabetes mellitus. Conclusions: Over the last 10 years at the Memphis VAMC, 180 patients have been diagnosed with RCC. The prevalence of past or current HCV infection in this RCC population is 15%. This rate is likely an underestimate of the true HCV prevalence given the fact that 22% of the 180 RCC cases had no prior HCV testing. Even at this conservative estimate, the 15% prevalence of HCV in the RCC population is far in excess of the HCV prevalence among the general VA and US populations, which have been estimated at 6% and 2%, respectively. Our data add further support to the emerging association between HCV and RCC and herald a need for additional research examining this link. Sa1074 Prevalence of Hepatitis C-Associated Thrombocytopenia Stratified by Liver Disease Severity, Antiviral Use and Co-Infection Status: Data From Three Large Integrated Delivery Networks in the US Sara A. Poston, Anna J. Swenson, Kathryn A. Starzyk, Ulla M. Forssen, Kelly M. Grotzinger Purpose: The clinical impact of chronic hepatitis C (HCV)-associated thrombocytopenia (TCP) is poorly understood, but affected patients are typically either not eligible for interferon- based therapy or are sub-optimally treated, which in turn decreases attainment of a sustained virologic response. Estimates of HCV-associated TCP vary widely and are difficult to compare due to the differences in disease severity and co-infection among populations, and in the platelet thresholds used to define TCP. The purpose of this study was to estimate the prevalence of TCP at a range of platelet thresholds and to stratify by liver disease severity, antiviral treatment status, and by co-infection status. Methods: This retrospective cohort study utilized an integrated database of EMRs (electronic medical records) obtained from three large US integrated delivery networks (IDNs). The IDNs included multispecialty group practices and their affiliated hospitals, and were chosen based on their geographical and demographic distribution. Eligible patients were at least 18 years of age with a diagnosis code of 070.54 (chronic HCV without hepatic coma) or 070.44 (chronic HCV with hepatic coma) in the EMR medical problem list and a minimum of two clinical encounters during the study period (01 January 2007 and 31 December 2011). TCP was defined as platelet count below the following thresholds: ,50,000/μL, ,75,000/μL, ,90,000/μL, ,100,000/ μL and ,150,000/μL. Point prevalence for each of these platelet levels was assessed using data from 2010, as it was the most recent year for which complete antiviral treatment records were available. Analyses were performed on the total population as well as on the subsets of patients receiving antiviral therapy, with select co-infections and with advanced liver disease. Results: 2,434 patients with chronic HCV had a clinical encounter in 2010, and 8.3% were treated with antiviral therapy during that calendar year. Mean age was 50.9 years, and 60.1% of the patients were male, 54.0% were white, 23.7% black and 3.7% Asian. In 2010, TCP prevalence ranged from 3.2% when less than 50,000/μL was used as the threshold to 24.1% when less than 150,000/μL was used (Table 1). The prevalence S-990 AASLD Abstracts ranged from 3.2% to 42.1% during antiviral treatment, and dropped after completion of treatment (range 2.5% to 15.0%). Prevalence was higher in the populations with HIV co-infection, documented cirrhosis and the population with decompensated liver disease. Conclusion: This is the largest US study of TCP in HCV patients using EMR data, and it represents a geographically and demographically diverse population. The size of the study allows for robust estimates of prevalence during antiviral treatment, in the presence of co- infection, and in the presence of advanced liver disease. Sa1075 Hepatitis C in the Amazon Rainforest Midiã B. Andrade, George V. Silva, Valter C. Neto, André P. Almeida, Felicien G. Vasquez, Lígia H. Freitas, Gabriel R. Di Tommaso, Mayara D. Ferreira, Juliana M. Moura, Carolina Silva, Renata F. Lima, Sanmya B. Oliveira, Adriana Malheiro, Felipe Naveca, Cristina M. Rocha Introduction: Hepatitis C (HCV) is a disease with a significant global impact. Brazil is a country characterized as intermediate endemicity, with few epidemiological data on the population of the Amazon rainforest. Objectives: To determine the prevalence of HCV in the habitants of the city of Iranduba, located 22 kilometers from the capital Amazonas, the largest state in the Amazon region, and identify risk factors. Methods: After approval by the ethics committee of the University of the State of Amazonas, this prospective study was conducted between May and October of 2012, in partnership with the county health department, which provided us a team of two nurses, eighteen nursing technicians and twelve community health workers. To the residents of the urban area were released day and places where anti-HCV testing were going to be offered as well as to the residents of rural areas, including the local population, the survey was made available in health centers or at their homes. After signing an informed consent term, the volunteers were subjected to an anti-HCV rapid test from Bioeasy@ and an epidemiological questionnaire. Results: 656 volunteers participated, from 19 neighborhoods spread between urban and rural areas. The standard deviation of age was ± 14.74, and 34.1% (225) were male and 65.9% (431) females. Regarding sexuality, 79.1% (517), were heterosexual. As for naturality, the majority were from the state itself, totaling 63.8% (417) of the sample. As for education, 7.9% (52) said they were illiterate, 28.3% (185) having attained secondary education and 8.1% (53) to enter higher education. Among the participants 11.3% (73) were health professionals. A total of 0.2% (1) related infection by human immunodeficiency virus. 4.8% (25) reported past history of jaundice and 39.2% (202) had relatives who were diagnosed with hepatitis at some point in life. For risk factors, 38.1% (250) reported daily consumption of alcohol, 20.9% (136) reported tattoos and/or piercings on the body and 4.9% (32) were injecting drug users and 22.5 % (18) received a blood transfusion before 1990. Of the 279 reports of surgery 2.5% (7) underwent some type of surgery before the 90s. One case was registered of anti-HCV reactive, with confirmation of the polymerase chain reaction real time, with genotype 2, was a female, mulatto, aged 62, with incomplete primary education, natural from the state of Amazonas, housewife, divorced, with a history of blood transfusion in 1992. Conclusion: The study showed prevalence of 0.2%, as characterizing the Amazon rainforest region of low endemicity for HCV, in contrast to the national average, diverging also the type of predominant genotype in the country, the type 1. Sa1076 Key Drivers and Barriers to Treatment Initiation and Adherence in Individuals With Hepatitis C Suchin Virabhak, Kathleen Beusterien, Suzanne Lane, Stephanie Kirbach, Shelagh Szabo, Eric Kallwitz, Jessica Grinspan, Katherine Gooch Background and aims: The current standard of care for patients with chronic hepatitis C virus (HCV) infection includes pegylated interferon. Interferon-containing therapy may be associated with side effects which may influence patients' decision to initiate, and ability to adhere to treatment. The objective of this study was to evaluate the key motivators and barriers to treatment initiation and adherence. Methods: This was a cross-sectional study involving an online survey and qualitative interviews from a convenience sample of individu- als with HCV in the United States. The online survey contained clinical questions related to HCV treatment experience. One-on-one interviews were conducted to understand motiva- tions for seeking HCV treatment and, among the treatment-experienced, treatment adherence and side effects were discussed. Results: Of the 138 participants in the online survey included in the analyses, 64 were treatment-naïve and 74, treatment-experienced. Compared to treatment-naïve participants, treatment-experienced participants were slightly older (p- value = 0.02), more likely to never have been a smoker (p-value=0.01), and more likely to have some health insurance coverage (p-value=0.001). 115 (83%) indicated that they were ‘hopeful' or ‘very hopeful' about their future health, and this was comparable between both groups. Among treatment-naïve participants, 59% were not planning to initiate treatment; key barriers included being asymptomatic, fear of side effects, and lack of health insurance. 34% of treatment-experienced participants had discontinued treatment in the past. In addi- tion, 24% reported that the treatment regimen was ‘somewhat' or ‘very difficult' to follow. 12 qualitative interviews were completed: 8 were treatment-experienced and 4 were treat- ment-naïve, but were planning to start treatment. The key drivers for starting HCV treatment were being symptomatic and doctor recommendation, a hope for a cure, the desire to no longer be contagious, and the desire to stop thinking about having the disease. Conclusions: Adherence to treatment is an important factor in obtaining a viral response, but may be challenging for patients to achieve. Although those with HCV who begin treatment may be motivated at the outset, a better understanding of the factors influencing patients to remain on therapy would be useful to help increase the proportion of those who ultimately achieve a viral response
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sbiopsy - Table 1. One patient was deemed cirrhotic radiologically and not biopsied. Theremaining 3/9 patients were not biopsied because of the bleeding risks. 8/9 (7M, 1F) HCVPCR +ve patients were treated with pegaylatedIFN/Ribavirin. 6/8 ( 2/4 G1, 3 G3.,1 G4) -75% -achieved SVR at 6 months and were deemed cured of HCV. 1 M (G1a) was a responder-relapser and 1M (G1a) was a null responder. There were no unexpected complicationsduring treatment. CONCLUSION: We have shown that few patients (3.6%) with bleedingdisorders have been infected with HCV despite repeated blood product infusions. There isa high cure rate and no patient required a liver transplant. As expected, genotype 1 wasthe commonest genotype in this cohort. All of our patients have had governmental compensa-tion from the Skipton Fund(1). Ref1:www.skiptonfund.orgLiver Biopsy Details-Table 1
Stage and grade of HCV infection in 4/11 patients infected with HCV during treatment forbleeding disorders.
Sa1073
Emerging Understanding of the Oncogenic Potential of Hepatitis C VirusInfection and the Association With Renal Cell CarcinomaMark Cahill, Jessica Burke, Bradford Waters
Purpose of Study: We aim to further elucidate the emerging association between renal cellcarcinoma (RCC) and hepatitis C virus (HCV). Methods Used: With institutional reviewboard approval, we obtained a list of all RCC diagnoses made at the Memphis VeteranAffairs Medical Center (VAMC) from 2002-2012. We then performed a retrospective chartreview of these patients. We also reviewed the national VA Hepatitis C registry. Summaryof Results: As of 2011, the number of veterans in the US who have ever had HCV viremiais 170,119. Of all US veterans with HCV viremia, 1,250 (0.7%) have ever been diagnosedwith RCC. At the Memphis VAMC, there have been 180 biopsy-proven diagnoses of RCCfrom 2002-2012. Of these patients, 140 (78%) have been tested for HCV infection. Amongthose tested for HCV infection, 27 (19%) had antibody seropositivity. Among the 27 HCVseropositive patients, 19 (70%) were viremic, 5 (19%) had an undectable viral load, and 3(11%) were never tested for HCV viremia. Presuming the 40 RCC patients who were nevertested for HCV infection were indeed HCV negative, the prevalence of past or current HCVinfection among RCC patients is 15% (27 of 180 cases). Among the 27 HCV seropositivepatients, the average age at diagnosis of RCC was 57 (range, 45-77), 100% were male, 59%were African American, 85%were tobacco abusers, 33%were obese, 11% had ESRD requiringhemodialysis prior to RCC diagnosis, 89% had hypertension, and 30% had diabetes mellitus.Conclusions: Over the last 10 years at the Memphis VAMC, 180 patients have been diagnosedwith RCC. The prevalence of past or current HCV infection in this RCC population is 15%.This rate is likely an underestimate of the true HCV prevalence given the fact that 22% ofthe 180 RCC cases had no prior HCV testing. Even at this conservative estimate, the 15%prevalence of HCV in the RCC population is far in excess of the HCV prevalence amongthe general VA and US populations, which have been estimated at 6% and 2%, respectively.Our data add further support to the emerging association between HCV and RCC and heralda need for additional research examining this link.
Sa1074
Prevalence of Hepatitis C-Associated Thrombocytopenia Stratified by LiverDisease Severity, Antiviral Use and Co-Infection Status: Data From ThreeLarge Integrated Delivery Networks in the USSara A. Poston, Anna J. Swenson, Kathryn A. Starzyk, Ulla M. Forssen, Kelly M.Grotzinger
Purpose: The clinical impact of chronic hepatitis C (HCV)-associated thrombocytopenia(TCP) is poorly understood, but affected patients are typically either not eligible for interferon-based therapy or are sub-optimally treated, which in turn decreases attainment of a sustainedvirologic response. Estimates of HCV-associated TCP vary widely and are difficult to comparedue to the differences in disease severity and co-infection among populations, and in theplatelet thresholds used to define TCP. The purpose of this study was to estimate theprevalence of TCP at a range of platelet thresholds and to stratify by liver disease severity,antiviral treatment status, and by co-infection status. Methods: This retrospective cohortstudy utilized an integrated database of EMRs (electronic medical records) obtained fromthree large US integrated delivery networks (IDNs). The IDNs included multispecialty grouppractices and their affiliated hospitals, and were chosen based on their geographical anddemographic distribution. Eligible patients were at least 18 years of age with a diagnosiscode of 070.54 (chronic HCV without hepatic coma) or 070.44 (chronic HCV with hepaticcoma) in the EMR medical problem list and a minimum of two clinical encounters duringthe study period (01 January 2007 and 31 December 2011). TCP was defined as plateletcount below the following thresholds: ,50,000/μL, ,75,000/μL, ,90,000/μL, ,100,000/μL and ,150,000/μL. Point prevalence for each of these platelet levels was assessed usingdata from 2010, as it was the most recent year for which complete antiviral treatment recordswere available. Analyses were performed on the total population as well as on the subsetsof patients receiving antiviral therapy, with select co-infections and with advanced liverdisease. Results: 2,434 patients with chronic HCV had a clinical encounter in 2010, and8.3% were treated with antiviral therapy during that calendar year. Mean age was 50.9years, and 60.1% of the patients were male, 54.0% were white, 23.7% black and 3.7%Asian. In 2010, TCP prevalence ranged from 3.2% when less than 50,000/μL was used asthe threshold to 24.1% when less than 150,000/μL was used (Table 1). The prevalence
S-990AASLD Abstracts
ranged from 3.2% to 42.1% during antiviral treatment, and dropped after completion oftreatment (range 2.5% to 15.0%). Prevalence was higher in the populations with HIVco-infection, documented cirrhosis and the population with decompensated liver disease.Conclusion: This is the largest US study of TCP in HCV patients using EMR data, and itrepresents a geographically and demographically diverse population. The size of the studyallows for robust estimates of prevalence during antiviral treatment, in the presence of co-infection, and in the presence of advanced liver disease.
Sa1075
Hepatitis C in the Amazon RainforestMidiã B. Andrade, George V. Silva, Valter C. Neto, André P. Almeida, Felicien G. Vasquez,Lígia H. Freitas, Gabriel R. Di Tommaso, Mayara D. Ferreira, Juliana M. Moura, CarolinaSilva, Renata F. Lima, Sanmya B. Oliveira, Adriana Malheiro, Felipe Naveca, Cristina M.Rocha
Introduction: Hepatitis C (HCV) is a disease with a significant global impact. Brazil is acountry characterized as intermediate endemicity, with few epidemiological data on thepopulation of the Amazon rainforest. Objectives: To determine the prevalence of HCV inthe habitants of the city of Iranduba, located 22 kilometers from the capital Amazonas, thelargest state in the Amazon region, and identify risk factors. Methods: After approval by theethics committee of the University of the State of Amazonas, this prospective study wasconducted between May and October of 2012, in partnership with the county healthdepartment, which provided us a team of two nurses, eighteen nursing technicians andtwelve community health workers. To the residents of the urban area were released dayand places where anti-HCV testing were going to be offered as well as to the residents ofrural areas, including the local population, the survey was made available in health centersor at their homes. After signing an informed consent term, the volunteers were subjectedto an anti-HCV rapid test from Bioeasy@ and an epidemiological questionnaire. Results:656 volunteers participated, from 19 neighborhoods spread between urban and rural areas.The standard deviation of age was ± 14.74, and 34.1% (225) were male and 65.9% (431)females. Regarding sexuality, 79.1% (517), were heterosexual. As for naturality, the majoritywere from the state itself, totaling 63.8% (417) of the sample. As for education, 7.9% (52)said they were illiterate, 28.3% (185) having attained secondary education and 8.1% (53)to enter higher education. Among the participants 11.3% (73) were health professionals. Atotal of 0.2% (1) related infection by human immunodeficiency virus. 4.8% (25) reportedpast history of jaundice and 39.2% (202) had relatives who were diagnosed with hepatitisat some point in life. For risk factors, 38.1% (250) reported daily consumption of alcohol,20.9% (136) reported tattoos and/or piercings on the body and 4.9% (32) were injectingdrug users and 22.5 % (18) received a blood transfusion before 1990. Of the 279 reportsof surgery 2.5% (7) underwent some type of surgery before the 90s. One case was registeredof anti-HCV reactive, with confirmation of the polymerase chain reaction real time, withgenotype 2, was a female, mulatto, aged 62, with incomplete primary education, naturalfrom the state of Amazonas, housewife, divorced, with a history of blood transfusion in1992. Conclusion: The study showed prevalence of 0.2%, as characterizing the Amazonrainforest region of low endemicity for HCV, in contrast to the national average, divergingalso the type of predominant genotype in the country, the type 1.
Sa1076
Key Drivers and Barriers to Treatment Initiation and Adherence in IndividualsWith Hepatitis CSuchin Virabhak, Kathleen Beusterien, Suzanne Lane, Stephanie Kirbach, Shelagh Szabo,Eric Kallwitz, Jessica Grinspan, Katherine Gooch
Background and aims: The current standard of care for patients with chronic hepatitis Cvirus (HCV) infection includes pegylated interferon. Interferon-containing therapy may beassociated with side effects which may influence patients' decision to initiate, and ability toadhere to treatment. The objective of this study was to evaluate the key motivators andbarriers to treatment initiation and adherence. Methods: This was a cross-sectional studyinvolving an online survey and qualitative interviews from a convenience sample of individu-als with HCV in the United States. The online survey contained clinical questions relatedto HCV treatment experience. One-on-one interviews were conducted to understand motiva-tions for seeking HCV treatment and, among the treatment-experienced, treatment adherenceand side effects were discussed. Results: Of the 138 participants in the online survey includedin the analyses, 64 were treatment-naïve and 74, treatment-experienced. Compared totreatment-naïve participants, treatment-experienced participants were slightly older (p-value = 0.02), more likely to never have been a smoker (p-value=0.01), and more likely tohave some health insurance coverage (p-value=0.001). 115 (83%) indicated that they were‘hopeful' or ‘very hopeful' about their future health, and this was comparable between bothgroups. Among treatment-naïve participants, 59% were not planning to initiate treatment;key barriers included being asymptomatic, fear of side effects, and lack of health insurance.34% of treatment-experienced participants had discontinued treatment in the past. In addi-tion, 24% reported that the treatment regimen was ‘somewhat' or ‘very difficult' to follow.12 qualitative interviews were completed: 8 were treatment-experienced and 4 were treat-ment-naïve, but were planning to start treatment. The key drivers for starting HCV treatmentwere being symptomatic and doctor recommendation, a hope for a cure, the desire to nolonger be contagious, and the desire to stop thinking about having the disease. Conclusions:Adherence to treatment is an important factor in obtaining a viral response, but may bechallenging for patients to achieve. Although those with HCV who begin treatment may bemotivated at the outset, a better understanding of the factors influencing patients to remainon therapy would be useful to help increase the proportion of those who ultimately achievea viral response
