Naive Chronic Hepatitis Research Articles

Factors influencing pathological changes in the liver tissue in hepatitis B virus carriers with low-level viremia

ObjectivesTo investigate the optimal timing for initiating antiviral therapy in hepatitis B virus (HBV) carriers with low-level viremia (LLV). MethodsWe retrospectively enrolled 126 HBV carriers with LLV who underwent liver biopsy. Patients’ clinical data, routine blood test results, portal vein diameter, splenic vein diameter and thickness, and measurements (LSM) within 1 week before liver biopsy were obtained. Single-factor and multifactor statistical methods were used to analyze factors that affected inflammation and fibrosis in pathological liver tissues. The receiver operating characteristic curve was used to analyze liver stiffness and HBV DNA levels to determine liver tissue inflammation and fibrosis. R -Studio software was used to draw nomograms, calibration plots, and model decision curves. ResultsInfection duration and HBV DNA levels affected liver tissue inflammation. Albumin(ALB), aspartate aminotransferase (AST), HBV DNA, liver stiffness, age, and splenic thickness affected liver fibrosis. The best cutoff value of the LSM for diagnosing liver inflammation and fibrosis was 7.45 (specificity, 92%). The best cutoff value of HBV DNA for diagnosing liver inflammation and fibrosis was 39.5 (specificity, 96%). HBV DNA,and splenic thickness affected the treatment decision in naive chronic hepatitis Bpatients with LLV ConclusionsHBV carriers with LLV have high incidences of liver tissue inflammation and fibrosis. The infection duration and HBV DNA levels affected liver inflammation whereas the ALB, AST levels, HBV DNA, LSM, age, and splenic thickness affected liver fibrosis. Eligible expansion of antiviral treatment indications is necessary, however, a universal treatment approach may be inefficient. HBV DNA can be a reference for initiating antiviral therapy.

Evaluation of the Correlation Between Serum Tumor Necrosis Factor Alpha, Transforming Growth Factor-Beta, Interleukin-10 and Alanine Aminotransferase Levels and Liver Histological Activity in Naive Chronic Hepatitis C Patients

Objective: In this study serum tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF- beta), interleukin-10 (IL–10) and alanine transferase (ALT) levels were measured in naive chronic hepatitis C patients and healthy control group. The relationship between the values and the histological activity of the liver was evaluated to make predictions about liver histology without the need for biopsy. Methods: A total of 86 individuals including 43 patients and 43 controls participated in the study. Serum AST, ALT, TNF-alpha, TGF- beta and IL–10 values were analyzed in patient and control groups. The correlation between liver fibrosis degree (stage) and histological activity index (HAI) scores and the IL–10, TNF-alpha, IL-10, TGF-BETA values of the case and control group was evaluated. Results: A very strong correlation was found between HAI and TNF-alpha (rho=0965). A significant relation was found between HAI and TGF-beta (rho=0.446) and statistical correlation was not found between HAI and IL-10. A significant relation was found between HAI and serum ALT values in the patient group. Conclusion: Liver biopsy is an invasive procedure with complications which may have severe results. There is a need for biochemical or radiological markers which extrapolate to liver biopsy. In our study, measurement of serum cytokine and ALT values was observed as a noninvasive method which can help to meet this need.

Viral nucleic acids suppression activity of RO7049389 plus NUC with/without Peg-IFN in virologically-suppressed and naive chronic hepatitis B patients: 48-week treatment and post-treatment follow-up

Viral nucleic acids suppression activity of RO7049389 plus NUC with/without Peg-IFN in virologically-suppressed and naive chronic hepatitis B patients: 48-week treatment and post-treatment follow-up

Dynamic Change of Albumin-Bilirubin Score Is Good Predictive Parameter for Prognosis in Chronic Hepatitis C-hepatocellular Carcinoma Patients Receiving Transarterial Chemoembolization.

Background and Aims: The Albumin-Bilirubin (ALBI) grade is a good index for liver function evaluation and is also associated with the outcomes of hepatocellular carcinoma patients receiving TACE. However, the correlation between the dynamic change to the ALBI score and clinical outcome is seldom discussed. Therefore, this study aimed to investigate the application of ALBI grade and dynamic change of ALBI grade (delta ALBI grade) after first TACE for prognosis prediction in HCC patients with chronic hepatitis C infection. Method: From January 2005 to December 2015, newly diagnosed naive chronic hepatitis C-hepatocellular carcinoma (CHC-HCC) patients who were treated with TACE as the initial treatment at the Chang Gung Memorial Hospital, Linkou Medical Center, were retrospectively recruited. The pre-treatment host factors, tumor status and noninvasive markers were collected. The Cox regression model was used to identify independent predictors of overall survival and tumor recurrence. Results: Among 613 treatment-naive CHC-HCC patients, 430 patients died after repeated TACE during a median follow-up of 26.9 months. Complete remission after repeated TACE occurred in 46.2% patients, and 208 patients (33.9%) had tumor recurrence, with a median recurrence-free interval of 8.5 months. In Cox regression analysis, ALBI grade II/III (aHR: 1.088, p = 0.035) and increased delta ALBI grade (aHR: 1.456, p = 0.029) were independent predictive factors for tumor recurrence. Furthermore, ALBI grade II/III (aHR: 1.451, p = 0.005) and increased delta ALBI grade during treatment (aHR: 1.436, p = 0.006) were predictive factors for mortality, while achieving complete response after repeated TACE (aHR: 0.373, p < 0.001) and anti-viral therapy (aHR: 0.580, p = 0.002) were protective factors for mortality. Conclusion: Both ALBI and delta ALBI grade are independent parameters to predict survival and tumor recurrence of CHC-HCC patients receiving TACE treatment.

Correlation of Fischer’s Ratio with Liver Fibrosis in Naive Chronic Hepatitis B Patients without Comorbidities

Introduction: Hepatitis B virus infection is one of the most common health problems in the world. 20% Chronic hepatitis B can can change into liver fibrosis. The liver is the center of the body's Amino Acids metabolism. Amino acid changes can occur due to impaired liver function. Fisher's ratio (BCAA/AAA) has become one of the sign of liver fibrosis. This study wanted to find a relationship between Fischer Ratio values and liver fibrosis in naive chronic hepatitis B patients without comorbidities. Method: The research was conducted from October 2020-May 2021 at DR. Moewardi Hospital, Surakarta, Indonesia. Subjects were naive chronic hepatitis B patients without comorbidities with a minimum age of 30 years. The study used a cross-sectional method. Fischer Ratio values were assessed by spectrophotometry and liver fibrosis was assessed by transient elastography (fibroscan). A correlation test was conducted to determine the relationship between variables. Result: 20 patients were included in the study. The average age of the research subjects was 47 ± 10 years. The average Fisher's ratio value was 2.83 ± 1.16 and the average fibroscan value was 17.31 ± 18.50 kPa. Ratio Fischer had a correlation with liver fibrosis with r= - 0.571 (p=0.004). Conclusions: Ratio Fischer has a negative correlation with liver fibrosis in naive chronic hepatitis B patients without comorbidities.

Assessment of erectile function and sexual hormones in chronic hepatitis C-infected patients treated with direct-acting antiviral agents

Objective To assess the erectile function, serum total testosterone, and serum prolactin levels in naive chronic hepatitis C virus (HCV)-infected patients before and after administration of direct-acting antiviral agents (sofosbuvir with daclatasvir). Design A descriptive cross-sectional study was conducted. Patients and methods A total of 50 married patients less than 60 years old with regular marital life having naive chronic HCV infection for a minimum of 1 year confirmed by positive serum HCV RNA by PCR who were going to receive 'sofosbuvir and daclatasvir' regimen for 3 months were included in the study. Intervention(s) Serum total testosterone and serum prolactin levels before and after the treatment course were assessed. Main outcome measure(s) The abridged form of International Index of Erectile Function questionnaire (IIEF-5) – Arabic version was fulfilled by the patients before starting the treatment course and 6 months afterward. Result(s) Before starting the treatment course, 28% of the study population complained of erectile dysfunction (IIEF-5 score ≤21). After the treatment course, the total IIEF-5 score was statistically significantly higher and the serum levels of total testosterone and prolactin hormones were statistically significantly lower than their levels before starting the treatment course. Conclusion(s) Direct-acting antiviral agents (sofosbuvir and daclatasvir) have demonstrated tolerability and safety regarding the erectile function; furthermore, there was significant improvement in the erectile function after the end of the treatment course.

Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis.

BACKGROUNDSimple tools for clinicians to identify cirrhosis in patients with chronic viral hepatitis are medically necessary for treatment initiation, hepatocellular cancer screening and additional medical management.AIMTo determine whether platelets or other laboratory markers can be used as a simple method to identify the development of cirrhosis.METHODSClinical, biochemical and histologic laboratory data from treatment naive chronic viral hepatitis B (HBV), C (HCV), and D (HDV) patients at the NIH Clinical Center from 1985-2019 were collected and subjects were randomly divided into training and validation cohorts. Laboratory markers were tested for their ability to identify cirrhosis (Ishak ≥ 5) using receiver operating characteristic curves and an optimal cut-off was calculated within the training cohort. The final cut-off was tested within the validation cohort.RESULTSOverall, 1027 subjects (HCV = 701, HBV = 240 and HDV = 86), 66% male, with mean (standard deviation) age of 45 (11) years were evaluated. Within the training cohort (n = 715), platelets performed the best at identifying cirrhosis compared to other laboratory markers [Area Under the Receiver Operating Characteristics curve (AUROC) = 0.86 (0.82-0.90)] and sensitivity 77%, specificity 83%, positive predictive value 44%, and negative predictive value 95%. All other tested markers had AUROCs ≤ 0.77. The optimal platelet cut-off for detecting cirrhosis in the training cohort was 143 × 109/L and it performed equally well in the validation cohort (n = 312) [AUROC = 0.85 (0.76-0.94)].CONCLUSIONThe use of platelet counts should be considered to identify cirrhosis and ensure optimal care and management of patients with chronic viral hepatitis.

An Immuno-Clinic score model for evaluating T cell immunity and predicting early antiviral therapy effectiveness in chronic hepatitis B.

We generated an Immuno-Clinic score (ICS) model to evaluate T cell immunity based on the clustering of antiviral cytokines and inhibitory molecules in 229 naïve chronic hepatitis B (CHB) patients. 126 patients receiving antiviral therapy were used to validate the model for predicting antiviral therapy effectiveness. Through receiver-operator characteristic curve analysis, the area under the curve, sensitivity, and specificity of the ICS model were 0.801 (95%CI 0.703-0.900), 0.727, and 0.722, respectively. The cut-off value was 0.442. Re-evaluation of T cell immunity in different phases of CHB showed that patients in the immune tolerant phase had the lowest percentage of ICS-high (15%), while patients in the inactive carrier phase had the highest percentage of ICS-high (92%). Patients in the immune active and gray zone phases had 17% and 56% ICS-high, respectively. Elevation of ICS as early as four weeks after treatment could predict the effectiveness of hepatitis B virus (HBV) DNA loss and normalization of alanine aminotransferase, while eight weeks after treatment could predict HBV surface antigen decline. Thus, this ICS model helps clinicians choose an optimal time for initiating antiviral therapy and predicting its efficacy.

Cellular Immune Response (CD8+CD38+) in Relation to Hepatitis B Virus DNA Level and HBsAg Quantification in Hepatitis B Patients

Introduction: Hepatitis B Virus (HBV) infection is a global public health concern. The immune response in HBV represents a key factor in patient outcome. However, the relationship between viral replication and host immune reactivity remains a matter of investigation. Aim: The aim of our study was to investigate whether the cellular immune response of recently diagnosed and treatment naive chronic hepatitis B(CHB) patients may be influenced by the replicative status of HBV. Towards this aim, the correlation between HBV viral load, HBsAg quantification and peripheral T-cell subpopulations CD8+CD38+. Methods: Proportions and absolute counts of CD8 CD38 T cells were determined using three-color flow cytometry in chronic hepatitis B patients (n=50) and healthy controls (n=35). Chronic hepatitis B patients were regularly followed for 48 weeks, during which period the T cell subsets, serum viral load and HBsAg quantitation were measured every 24 months. Results: There was a high level of CD8+CD38+% during the pretreatment stage (Mean 32.4514, standard deviation (SD) 16.8007) compared to the control group (Mean 19.4628, SD 9.75555), p=0.000. Significant decreases in CD8 count were detected 12 months after treatment initiation of HBV therapy (Mean 1359.44, SD 724.362) compared to the control group (Mean 1944.13, SD 948.931), p=0.001. There is a significant correlation between CD8+CD38+ count and serum HBV DNA. A Positive correlation was found between CD8+CD38+ count and HBsAg quantitation. Conclusion: There was a positive correlation between CD8+CD38+ T cells and HBsAg quantitation. The combined use of CD8+CD38+ T cells, HBsAg quantitation and HBV DNA assessment in patients with CHB may guide the clinicians as they guage the likelihood of treatment response.

Morbidity and mortality during hepatitis C treatment using sofosbuvir and daclatasvir with or without ribavirin, in a cohort of Egyptian patients.

Though direct-acting antiviral agents (DAAs) therapy is associated with a high cure rate of hepatitis C virus infection, a potential risk of serious adverse events (SAEs) exists. The aim of this study was to determine the incidence and predictors of morbidity and mortality related to DAAs therapy. This prospective study was conducted on a real word cohort of 1562 treatment naïve chronic hepatitis C (CHC) Egyptian patients, who received 12-weeks therapy with sofosbuvir (SOF) plus daclatasvir (DCV) ± ribavirin (RBV). The incidence and predictors of SAEs and mortality during treatment course and over the following 12 weeks were recorded. The mean age of study participants was 51.38 ± 9.70 years (55.22%, males). Liver cirrhosis was defined in 72.4% of participants. SAEs were recorded in 120 participants (7.68%), including hepatic decompensation, gastrointestinal bleeding, anemia and hepatocellular carcinoma. Nine patients (0.58%) died and 69 patients (4.42%) discontinued therapy due to SAEs. Severity of cirrhosis was the significant predictor of morbidities and mortality. Hepatic decompensation was predicted by baseline serum albumin [cutoff value: 3.00 g/dL, area under the receiver operating characteristic curve (AUROC): 0.953] and serum bilirubin (cutoff value: 1.75 mg/dL, AUROC: 0.940). The risk of morbidity and mortality related to SOF/DCV ± RBV therapy in CHC patients is small and is significantly linked to advanced cirrhosis.

The effect of direct antiviral treatment on the depression, anxiety, fatigue and quality-of-life in chronic hepatitis C patients.

In this study, we aimed to investigate the effects of direct antiviral treatment on depression, anxiety, fatigue and quality of life in patients with chronic hepatitis C. Subjects included in study were treatment experienced and treatment naive chronic hepatitis C patients admitted to the hepatology outpatient clinic between December 2016 and June 2017. Before and after the treatment, Beck depression, Beck anxiety, liver-specific quality of life and fatigue severity-impact scales were administered. Descriptive statistical methods, Kolmogorov-Smirnov distribution test Wilcoxon sign and kappa coefficient tests were used to evaluate the study data. Forty-four patients were included in the study; however, it was completed with 35 patients only, as some of the patients were excluded for various reasons. There was no significant difference between depression and anxiety scores of the patients before and after the treatment, but depression and anxiety were found to be recovered in 28.5% (4/14) and 23.5% (4/17) of the subjects, respectively. At the end of the treatment, fatigue severity-impact scales and liver-specific quality of life were not significantly different from those before the treatment. In this study, we found that direct antivirals did not lead to depression, anxiety or fatigue and did not decrease liver-specific quality of life. In some cases, depression and anxiety decreased after the treatment.

2238 An Unusual Case of Direct Acting Antiviral Potentiating Angioedema

INTRODUCTION: Hepatitis C Virus (HCV) is a leading cause of chronic liver disease and the most common reason for liver transplantation in the United States (US). The aim of direct acting antiviral (DAA) agents is to reduce progression to cirrhosis. There are newer well tolerated all-oral DAA agents, such as glecaprevir and pibrentasvir (GLE/PIB). We report an unreported adverse event in a treatment naive chronic hepatitis C genotype 1a patient: GLE/PIB induced angioedema. CASE DESCRIPTION/METHODS: A 63-year-old African American Male with a history of chronic hepatitis C infection (genotype 1a) without cirrhosis and hypertension on chronic lisinopril presented to the Emergency Room (ER) with acute onset facial and lip edema. Patient denied known environmental, food, or medication allergies. He denied unusual food intake. He recently started GLE/PIB. Vital signs were unremarkable. On physical examination, there was significant facial and lip swelling. Given the timing of symptoms, the side effect was suspected to be secondary to GLE/PIB. At this time, it was decided to stop the DAA and he was treated with steroids and antihistamine agents. At follow-up, the facial and lip edema had completely resolved. The HCV RNA level was obtained and surprisingly undetectable after only 4 days of therapy with a baseline of 5,080,000 IU/mL. However, at 12 week follow-up, he was again positive. DISCUSSION: Although GLE/PIB has a relatively good safety profile, angioedema is a potentially life threatening side effect that has not been reported as commonly. The underlying mechanism is not known, however it was hypothesized that co-administration with an Angiotensin Converting Enzyme (ACE) inhibitor may be related. We would recommend avoiding co-administration to prevent the rare but significant side effect, eliminating a potentially curative treatment regimen and the financial aspects of wasted expensive medication and expenses associated with hospitalization.

963 Treatment Failure With Daclatasvir Plus Sofosbuvir With or Without Ribavirin in Treatment Naïve Patients With Chronic Hepatitis C Without Cirrhosis

INTRODUCTION: Chronic hepatitis C treatment has been transformed by advent of DAAs. Pakistan is one of worst affected country with hepatitis C with recent suggested prevalence of 4.9%. Current AASLD guidelines recommend treatment with daily sofosbuvir plus daclatasvir with or without addition of weight based ribavirin. However this regimen is not first line recommendation. These drugs are available free of cost in government run setups. However it has raised questions about treatment failure with them and need for other DAAs. METHODS: This cross-sectional study is being conducted at ABSTH Gujrat from Oct. 2018 after approval of IRB and informed consent of patients using non-probability consecutive sampling. No genotyping is being done. Cirrhosis is considered when abdominal ultrasound shows coarse echotexture of liver as either Shear Wave Elastography or Fibroscan are not available. Treatment naive chronic hepatitis C patients without cirrhosis are being included. Patients on PCR testing having viral load of &lt;400000 IU/L are being considered to have low viral load and are being given 12 weeks regimen of daclatasvir plus sofosbuvir. Patients with having viral load of &gt;400000 IU/L are being considered to have high viral load and are being prescribed 24 weeks regimen of daclatasvir plus sofosbuvir with weight based ribavirin. ETR and SVR24 at 24 weeks are being noted. Patients who fail to achieve SVR24 after achieving ETR are being declared as treatment failure. Data analysis is being done using SPSS 20.0. RESULTS: 1073 patients have been included this study till now. Mean age is 46.01 + 11.50 years. 712(66.4%) are female and 361(33.6%) are male. 729(67.9%) patients with low viral load received daclatasvir plus sofosbuvir for 12 weeks while 344(32.1%) patients with high viral load received daclatasvir, sofosbuvir and weight based ribavirin for 24 weeks. ETR and SVR24 have been reported of 163(15.2%) patients till now. All these patients achieved ETR however only 161 patients achieved SVR24. One patients had high viral load while other had low. Treatment failure rate is 1.23% till now but exact figure can only be predicted after completion of study as more results are awaited. CONCLUSION: Treatment failure rate in treatment naive chronic hepatitis C patients without cirrhosis with daclatasvir plus sofosbuvir with or without ribavirin is low. Similar results have been reported previously. However these preliminary results show that there is need to investigate the factors leading to treatment failures.

THU-195-An open-label, randomized, active control trial of 8 versus 12 weeks of elbasvir/grazoprevir for naive chronic hepatitis C genotype 1b patients with mild fibrosis (EGALITE): Impact of baseline viral loads and NS5A resitance-associated substitution

THU-195-An open-label, randomized, active control trial of 8 versus 12 weeks of elbasvir/grazoprevir for naive chronic hepatitis C genotype 1b patients with mild fibrosis (EGALITE): Impact of baseline viral loads and NS5A resitance-associated substitution

SAT-478-Comparison of prediction models for hepatocellular carcinoma development in treatment naive chronic hepatitis B patients with cirrhosis

SAT-478-Comparison of prediction models for hepatocellular carcinoma development in treatment naive chronic hepatitis B patients with cirrhosis

Assessment of Efficacy, Reliability, Side Effects and Patient Compliance of Entecavir in Turkish Patients with Nukleos(T)ide Analogues Naive Chronic Hepatitis B

Assessment of Efficacy, Reliability, Side Effects and Patient Compliance of Entecavir in Turkish Patients with Nukleos(T)ide Analogues Naive Chronic Hepatitis B

Comparative Study between Fibro-Test and Egy-Score as Non-Invasive Markers for Assessment of Hepatic Fibrosis in Chronic Hepatitis C

Backgound: Liver fibrosis (LF) occurs in response to almost all causes of chronic liver injury. Assessing LF is important for both predicting disease progression and monitoring efficacy of therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of discriminating between “insignificant”, (F0-F1) by METAVIR and clinically “significant” fibrosis (≥ F2) by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated chronic liver disease. Both these aims are clinically the most relevant. Aim: We aimed to compare the diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a prospectively enrolled cohort of Egyptian patients with chronic hepatitis C. Patients and Methodlogy: Twenty patients, treatment naive chronic hepatitis C patients were enrolled. They were 16 males (80%) and 4 females (20%) mean age of these patients was 53.55 +14.3 (rang 18_73 years). The study was carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar University during the period between March 2016 and March 2018. Results: Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters (total bilirubin, albumin, platelet count) in addition to age and 2 non routine tests (CA 19-9 and Alpha-2-Macroglobulin). Although this panel needs to be done in validated laboratories, the cost of our score is much cheaper than other well-known and patented tests such as FibroTest and the net results of both methods nearly the same. Conclusion: Egy-Score can be applied easily in clinical practice to exclude severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are reluctant to do it. Egy-score would need further valida‌tion to be regarded as an alternative to liver biopsy. Recommendations: Physician should be careful when interpreting elevated levels of tu‌mor markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may give false positive results for our scores which give Limitations to our study.

Novel Side Effect of a Novel Medication

Introduction Glecaprevir/pibrentasvir (Mavyret) is a combination drug containing glecaprevir (100 mg) and pibrentasvir (40 mg). In the United States, it was approved by the Food and Drug Administration in August 2017 for treatment of hepatitis C. In Europe, it was also approved in August 2017 for the same indication. Here we report a new side effect of reversible hand tremors associated with the use of this drug. Case presentation This case involves a 45-year-old female with 1-year history of treatment naive chronic hepatitis C secondary to intravenous drug abuse. She had HCV viral load of 6.98 IU/ml, indeterminate genotype and ultrasound liver elastography showed mild to moderate fibrosis. She was started on 3 daily tablets glecaprevir/pibrentasvir for 8 weeks. 2 weeks into the treatment, she developed hand tremors, epigastric pain and gastroesophageal reflux. ON examination, she had fine resting tremors involving the fingers. She denied taking any other prescription or over the counter medication. Medication was stopped, and all symptoms improved in 3-4 days. Discussion Glecaprevir/pibrentasvir (MAVYRET) is a fixed-dose combination of glecaprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor, and pibrentasvir, an HCV NS5A inhibitor, and is indicated for the treatment of patients with chronic HCV genotype (GT) 1, 2, 3, 4, 5 or 6 infections without cirrhosis and with compensated cirrhosis (Child-Pugh A). Known side effects include hepatitis B reactivation, and more commonly increased serum bilirubin, headache, nausea, tiredness, and diarrhea. Our patient with Hepatitis C was started on glecaprevir/pibrentasvir and developed fine hand tremors after 2 weeks of treatment. This side effect was reversible and completely went away after stopping the medication.

Comparative Study between Fibro-Test and Egy-Score as Non-Invasive Markers for Assessment of Hepatic Fibrosis in Chronic Hepatitis C

Backgound: Liver fibrosis (LF) occurs in response to almost all causes of chronic liver injury. Assessing LF is important for both predicting disease progression and monitoring efficacy of therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of discriminating between “insignificant”, (F0-F1) by METAVIR and clinically “significant” fibrosis (≥ F2) by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated chronic liver disease. Both these aims are clinically the most relevant. Aim: We aimed to compare the diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a prospectively enrolled cohort of Egyptian patients with chronic hepatitis C. Patients and Methodlogy: Twenty patients, treatment naive chronic hepatitis C patients were enrolled. They were 16 males (80%) and 4 females (20%) mean age of these patients was 53.55 +14.3 (rang 18_73 years). The study was carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar University during the period between March 2016 and March 2018. Results: Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters (total bilirubin, albumin, platelet count) in addition to age and 2 non routine tests (CA 19-9 and Alpha-2-Macroglobulin). Although this panel needs to be done in validated laboratories, the cost of our score is much cheaper than other well-known and patented tests such as FibroTest and the net results of both methods nearly the same. Conclusion: Egy-Score can be applied easily in clinical practice to exclude severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are reluctant to do it. Egy-score would need further valida‌tion to be regarded as an alternative to liver biopsy. Recommendations: Physician should be careful when interpreting elevated levels of tu‌mor markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may give false positive results for our scores which give Limitations to our study.

SAT-379 - Whole genome viral sequencing reveals subgenotype specific dynamics of antiviral treatment response in HBeAg positive and treatment naive chronic hepatitis B patients

SAT-379 - Whole genome viral sequencing reveals subgenotype specific dynamics of antiviral treatment response in HBeAg positive and treatment naive chronic hepatitis B patients