Positive HCV Serology Research Articles

Noninvasive assessment and risk factors of liver fibrosis in pediatric patients with beta thalassemia major using transient elastography

BackgroundIn beta-thalassemia major (TM) patients, levels of liver iron overload and the presence of chronic hepatitis C are directly correlated with the onset and severity of liver fibrosis. A noninvasive approach that can evaluate cirrhosis and liver fibrosis in these patients is transient elastography (TE). We aimed to find out the role of noninvasive elastography in the assessment of liver fibrosis in young beta-thalassemia major patients receiving frequent blood transfusions. Identifying the patients' risk factors for liver fibrosis is another goal. The study comprised 53 patients, all of whom had a thorough history-taking procedure, clinical examination, and investigations such as CBC, serum ferritin, HCV and HBV serology, and liver function testing. It was carried out transient elastography to find liver fibrosis.ResultsAccording to transient elastography, 52.8% of the patients had severe fibrosis (F2 and higher). 9.4% of people had positive HCV serology results. Significant liver fibrosis was correlated with all serum ferritin levels (708.2 ± 182.1, 3213.5 ± 1272.9, nonsignificant vs. significant fibrosis), HCV infection, age, blood transfusion frequency, and irregular chelation therapy. But no significant correlation regarding sex and BMI was detected.ConclusionTransient elastography is an alternate noninvasive approach that assesses liver fibrosis in beta-thalassemia major patients. The risk of liver fibrosis is related to iron overload, HCV seropositivity, advanced age, frequent blood transfusion, and irregular chelation therapy.

Chronic hepatitis C in hemodialysis patients: Prevalence and liver fibrosis impact in the National Center for Renal Health in Peru

Hepatitis C (HCV) remains a serious public health problem in high-risk persons such as patients on chronic hemodialysis. We aimed to estimate the serological prevalence of HCV, the HCV viral load and genotype, and liver fibrosis stage among patients on chronic hemodialysis at the National Renal Health Center in Lima, Peru. From June 2019 to March 2021, all patients who received chronic hemodialysis were invited to participate. Subjects who provided written informed consent were enrolled. Patients with HCV-positive serology underwent determination of HCV viral load. Samples from subjects with detectable viral load, underwent determination of HCV genotype. Then, HCV infected subjects underwent determination of liver fibrosis using transitional elastography (Fibroscan 402): Metavir score: F0–F1: 2.5–7.5 kPa, F2: 7.6–9.5 Kpa, F3: 9.6–12 Kpa, F4 (Cirrhosis): 12.1–75 Kpa. Of the 303 subjects invited to participate, 174 (57.4%) subjects gave their written consent. Mean age was 52 years (range 22–91) and 116 (66.6%) were male. HCV serology was positive in 35.1% of patients (61/174); however, the prevalence of positive serology with detectable viral load was 20.11% (35/174). Genotype 1a was the most prevalent (85%). The majority (83.6%) of subjects with detectable viral load had values lower than 800.000 IU/mL. Twenty-nine of those 35 subjects underwent elastography evaluation, and 13 (44.8%) of them were found to have stage F2–F4 fibrosis. The prevalence of HCV at the largest reference center for hemodialysis in Lima remains high, with GT1a predominance, viral load usually below 800,000 IU/mL and significant liver fibrosis.

Timely Hepatitis C RNA Testing and Treatment in the Era of Direct-Acting Antiviral Therapy among People with Hepatitis C in New South Wales, Australia.

This study aimed to identify the factors associated with timely (within four weeks) HCV RNA testing and timely (within six months) DAA initiation following HCV notification in the DAA era. We conducted a cohort study of people with an HCV notification in NSW, Australia. Notifications of positive HCV serology were linked to administrative datasets. Weights were applied to account for spontaneous clearance. Logistic regression analyses were performed. Among 5582 people with an HCV notification during 2016–2017, 3867 (69%) were tested for HCV RNA, including 2770 (50%) who received timely testing. Among an estimated 3925 people with chronic HCV infection, 2372 (60%) initiated DAA therapy, including 1370 (35%) who received timely treatment. Factors associated with timely HCV RNA testing included age (≥30 years), female sex, non-Aboriginal ethnicity, country of birth being Australia, and no history of drug dependence. Factors associated with timely treatment were age (≥30 years), male sex, non-Aboriginal ethnicity, country of birth being Australia, no history of drug dependence, and HCV/HIV co-infection. In the DAA era, 50% of people with an HCV notification did not receive timely HCV RNA testing. Most people with an HCV infection received therapy; however, DAA initiation was delayed among many.

TEST AND CURE Towards hepatitis C Micro Elimination by Increase Outreach Linkage to Care by use of HCV Viral Load Real Time Measure and Same Day Treatment

Introduction and objective: HCV treatment for all was effective in France since 2017. HCV testing, diagnosis and treatment of drugs users and precarious people remain low. Lost follow-up was too important since several stages are necessary. Pangenotypic direct antiviral agents were available. Point-of-care HCV RNA testing offers advantage over antibody testing, enabling diagnosis of active infection with real time measure in a single visit. It is missing link between HCV RDT, liver fibrosis evaluation by FIBROSCAN and treatment. Validated Xpert HCV Viral Load assay CEPHEID, fast training technique, allow developing projects of diagnosis to treatment session. Our objective was to evaluate test to cure session allowing the access in 5 hours to an antiviral treatment to vulnerable and precarious populations (drug users, migrants, psychiatric patients). Materials and methods: Eligible patients had to have known positive serology or risk behavior, an unknown or unchecked viral load after antiviral treatment; 5 to 7 patients were recruited per each session by social or nursing interview. Between 9 am and 2 pm these patients had access to measure of the hepatic fibrosis by FIBROSCAN, HCV viral load in real time by CEPHEID Xpert HCV Viral load finger-stick samples, social interview, shared educational evaluation, collective workshops, especially harm reduction, depiction of results by hepatologist and prescription of DAA (sofosbuvir velpastasvir combination) allowed delivery of 1st month of treatment. Specific social and nursing follow-up was made during and after treatment. Compliance and sustained virological rate were determinate at week 12. Results: From October 2019 to December 2021, 223 sessions were realized on 27 sites: 9 drug units, one prison, 17 social units; 1602 patients with drug using history were screened; 427 patients had HCV positive serology and 24 patients did not come; 403 FIBROSCAN measures and 403 measures of viral load in real time were realized. Mean value of liver stiffness was 8.2 and 29% of patients were F3 or F4: 229 patients were HCV RNA positive (56.8%), 57 declared knew their HCV status; 228 treatments began same day, only 1 was delayed due to default social rights; 120 patients had a negative viral load spontaneously and 54 following prior treatment; 399 social interviews and 405 collective workshops were realized. On 31st January 2022, 207 antiviral treatments were completed and 199 patients were cured; 12 patients interrupted treatment; 3 patients relapsed and 5 reinfections; 89% of patients were satisfied with this program. Conclusions: Despite 3 months interruption by COVID 19 pandemic lockdown and sanitary restrictions, 94% of positive participants were linked to care and cure with this mobile clinic model, by screening and RNA real time measure in unity of place adapted to precarious public, patients distant from system of care had access immediately to treatment.

Transferability Of Results From Randomized Trials To Clinical Practice: The Case Of Diffuse Large B Cell Lymphoma Patients Treated With R-CHOP When Comorbidities Are Present

BackgroundImmuno-chemotherapy with Rituximab and CHOP (R-CHOP) represents the standard of care for Diffuse Large B Cell Lymphoma DLBCL patients of any age. The clinical outcome of patients treated by this program has been reproducibly confirmed by many independent randomized clinical trials that recruited patients on the basis of restrictive inclusion/exclusion criteria. Few information is available about the short and long term outcome of patients who, in the daily clinical practice, are treated by R-CHOP despite the presence of one or more co-morbidities that should have been considered as exclusion criteria for the aforementioned clinical trials. AimTo evaluate the response rate, the early death as well as overall survival of DLBCL patients who received a front-line R-CHOP or R-CHOP/like programs despite the presence at diagnosis of one or more severe comorbidities. PatientsFrom April 2000 to March 2013 we evaluated 473 consecutive and unselected DLBCL homogeneously treated at our institution with R-CHOP or R-CHOP/like as first line treatment. These patients were males in 53%, had a median age of 64 years (range 18 -89), clinical stage III-IV in 54%, B symptoms in 31%, bone marrow involvement in 14%, Bulky disease (> 7 cm) in 34%, Extranodal presentation (>1 site) in 30%, ECOG (>2) in 25%, a high LDH level in 48% and high IPI (>2) in 42%. For the present analysis, patients were divided in group A (n=257) and B (n=216) according to whether they met or not clinical trial enrollment criteria respectively (as reported by Cunningham et al, Lancet 2013). Reasons for not meeting these criteria were the following organ dysfunctions: cardiovascular (75%), liver (35%), lung (14 %) and renal (5%) or the presence of a positive serology for HCV, HBV and HIV that were detected in 73%, 38% of and 10% of these patients, respectively. Of note, 41 patients (8%) had a previous solid tumor. Overall 63% of patients had only one comorbidity, 30% more than two and 6% more than three. ResultsGender and patients with bulky disease were equally distributed between group A and B. However, patients belonging to group A were younger (58 vs 70, p=0.0001), had a less advanced stage disease (stage III and IV 46% vs 54, p= 0,001), fewer B symptoms (45% vs 55%, p= 0,024), less BM infiltration (34% vs 65%, p= 0,002), less extranodal involvement (42% vs 57%, p= 0,004) and showed a better performance status (ECOG >2 41% vs 59%, p= 0,005), a lower proportion of cases with high LDH level (46% vs 54%, p= 0,002) and a better IPI (IPI >2, 40% vs 60%, p= 0,000). After 6 chemotherapy cycles, the response rate was slightly lower in group B (82% vs 89%, p=ns). The proportion of early deaths (events registered within 6 months from start of chemotherapy), was lower in group A (7/257, 2.7%) as compared to group B (22/216, 10.2%, p=0.001), independently of age (> or<60 year). Of note, the early death rate in group A reproduced that seen in several randomized clinical trials. Main reasons of early death were: bacterial infections, acute liver failure, myocardial infarction and progressive disease. The median time to early death was 1.8 months in group A as compared to 2.35 in group B (p= ns), respectively. By multivariate logistic regression analysis, corrected by age, IPI and bone marrow positivity, the presence of B symptoms (OR 3.32, 95% CI 1.23-9.01, p= 0.018) and the presence of any comorbidity (OR 3.13, 95% CI 1.07-9.14, p= 0.037) proved as strongly independent predictors of early deaths. The 2 year probability of overall survival was 87% and 72% (p= 0.0001) in group A and B, respectively (Figure 1). B symptoms, and the presence of any comorbidity and IPI >2 were also significantly affecting the long term overall survival (B symptoms, HR 1.59, 95% CI 1.04-2.43; any comorbidity, HR 1.71, 95% CI 1.12-2.61; IPI >2, HR 2.38, 95% CI 1.48-3.82). Based on this analysis, we finally identified three risk categories: low (no B symptoms, no comorbidity and no high IPI), intermediate (presence of either B symptoms or any comorbidity or high IPI) and high (co-presence of B symptoms, any comorbidity and High IPI) that were associated to a significantly different 2 year survival of 93%, 81% and 48% (p= 0.0000), respectively. ConclusionsThe clinical outcome of a large proportion of DLBCL patients treated in the daily clinical practice is negatively affected by comorbidities. This should be considered when analyzing transferability of results from randomized clinical trials into clinical practice. [Display omitted] Disclosures:Rambaldi:Roche, SpA, Italy: Consultancy, Honoraria.

Real Life Data on Clinical Aspects and Treatment of Marginal Zone Lymphoma: An Analysis from the NF10 Project, an International, Prospective, Observational Study of the Fondazione Italiana Linfomi

Real Life Data on Clinical Aspects and Treatment of Marginal Zone Lymphoma: An Analysis from the NF10 Project, an International, Prospective, Observational Study of the Fondazione Italiana Linfomi

Retrieval of lost patients in the system for hepatitis C microelimination: a single-center retrospective study

BackgroundHepatitis C virus (HCV) is one of the major causes of chronic liver disease, cirrhosis, and liver cancer. Most of the infected people have no clinical symptoms. The current strategy for HCV elimination includes test and treatment. In this study, we aimed to evaluate the campaign for retrieving patients who were lost to follow-up, for subsequent re-evaluation.MethodsFrom January 2020 to October 2020, patients who had prior tests for positive anti-HCV antibody in 2010–2018 in our hospital were enrolled for our patient callback campaign. Patients who had unknown HCV RNA status or no documented successful antiviral therapy history were selected for anti-HCV therapy re-evaluation. To facilitate patient referral in the hospital, we developed an electronic reminding system and called the candidate patients via telephone during the study period.ResultsThrough the hospital electronic system, 3783 patients with positive anti-HCV antibody documentation were identified. Among them, 1446 (38.22%) had tested negative for HCV RNA or had anti-HCV therapy, thereby excluded. Of the 2337 eligible patients, 1472 (62.99%) were successfully contacted and called back during the study period for subsequent HCV RNA testing and therapy. We found that 42.19% of the patients had positive HCV RNA and 88% received subsequent anti-HCV therapy.ConclusionsA significant number of patients with positive HCV serology were lost for HCV confirmatory test or therapy in the hospital. Therefore, this targeted HCV callback approach in the hospital is feasible and effective in achieving microelimination.

Upper Gi Endoscopy-indications and Findings at Tertiary Care Hospital Hyderabad/Jamshoro

Objective: To document different indications and findings of upper GI Endoscopy in our endoscopy suite.&#x0D; Methods: A descriptive study of 500 patients who underwent upper gastrointestinal (UGI) endoscopy was conducted in the Endoscopy Unit of PNS DRIGH LUMHS Jamshoro and Civil Hospital Hyderabad from April to September 2020. Included patients underwent UGI endoscopy. Demographic data including indications and endoscopic findings of the patients was collected via study proforma.&#x0D; Results: Total five hundred patients were studied; their mean age was 42.4±16.8 years. Out of all 52.8% were males. Upper GI bleed was the commonest indication (33.2%) followed by dysphagia (21.6%), epigastrium pain (10%), surveillance and screening of varices (9% and 8.2% respectively). The most common endoscopic findings were esophageal varices (32.2 %), gastritis (18.8%), and normal (11.4%). In patients with esophageal varices, 77.4% had chronic liver disease with positive serology for HCV and HBV in 63.4% and 23% respectively.&#x0D; Conclusion: The most common indication was upper GI bleed with esophageal varices for upper GI endoscopy. The underlying etiology of varices reflects the high burden of chronic liver disease due to viral hepatitis.

False Positive Hepatitis C Virus Serologies in Pediatric Patients with Left Ventricular Assist Devices

Introduction Left ventricular assist devices (LVAD) are being used more frequently in pediatric patients with advanced heart failure as a bridge to transplant. Pediatric centers began implanting the HeartMate 3 LVAD in 2017 and it has become the LVAD of choice at many centers, including our own. Allosensitization is commonly observed after LVAD placement, resulting in higher frequencies of auto-antibodies, though the pathophysiology of this phenomenon is not well understood. Viral hepatitis screening is done prior to transplant, but there are no current guidelines on type of testing and timing with regards to LVAD placement. Case Report Three pediatric patients, aged 7-12 years old, each received an LVAD as bridge to orthoptic heart transplant (OHT) between May 2019 - September 2020. All were otherwise healthy and had negative hepatitis C (HCV) antibody tests prior to Heartmate 3 LVAD placement as part of the pre-transplant infectious work up. Repeat HCV serologic testing obtained shortly before cardiac transplant were positive in all three patients. The patients had no signs or symptoms of acute HCV infection, received infrequent blood transfusions between LVAD placement and OHT, and had no increased risk behaviors. Concurrent HCV quantitative PCR testing was done in two patients and both were negative. HCV antibody testing repeated within six weeks from LVA removal was negative in all three patients. Summary False positive HCV serology secondary to immunogenicity of LVADs has been described in adult literature. Our case series is the first, to our knowledge, to be described in pediatric patients. Adult data suggests that the false positive HCV serology can occur in 16-59% of cohorts post-LVAD. This is thought to be due to immunogenicity of the LVAD as serologies revert after the LVAD is explanted. Our experience demonstrates the importance of standardizing HCV testing in patients both pre- and post-LVAD as a bridge to OHT. Furthermore, acquisition of hepatitis C infection is rare in children and pediatric cardiac transplant providers should be aware of the possibility of false positive HCV antibody tests in this clinical scenario and the importance of confirmatory testing with quantitative PCR if concerned.

HCV micro-elimination in two prisons in Milan, Italy: A model of care.

People in prison represent a high-risk population for HCV infection control. With the advent of new direct antiviral agents (DAAs) HCV micro-elimination in prison setting became a feasible strategy. We assessed the impact of an intervention for HCV testing and treatment in 2017 and 2018 in a jail (San Vittore,SV) and a prison for sentenced individuals (Opera,OP). A dedicated protocol was applied and implemented over the two years. We collected data on demographics, HCV testing and treatment on all inmates present on 31 October 2017 and 2018. In the two facilities, there were 2,366 and 2,369 inmates in 2017 and 2018 respectively; the majority were men (95.6%; 96.4%) and Italians (57.0%; 61.9%) with a median age of 41years. Prevalence of lifetime reported drug use remained high (46.5%; 44.2%). HCV screening coverage was 89% in both years, while HCV RNA test coverage increased (90.6%; 99.0%). HCV seroprevalence remained stable (10.1%; 9.2%). In 2017 among inmates with HCV chronic infection 90 (42.4%) individuals had started DAAs treatment and 106 (54.6%) in 2018; of whom 38 (17.9%) and 74 (38.1%) achieved the SVR. The viremic pool decreased significantly over time (SV,24.4%; 15.4%;OP, 16.1%; <1%). Among inmates with HCV-positive serology in 2018, 121 (81.0%) were never linked to care before incarceration. Our study showed how a targeted and well-implemented HCV test-and-treat intervention in prison was feasible and effective in achieving micro-elimination. Viral hepatitis elimination agenda may help drawing interest onto this neglected population and bringing prison health higher up in the global public health agenda.

IBCL-019: Waldenström Macroglobulinemia (WM) in a Public Health Service in Sao Paulo, Brazil

Context: WM is a rare indolent non-Hodgkin lymphoma that mainly affects people over 60 years old. It is characterized by lymphoplasmacytic cells bone marrow infiltration and IgM gammopathy. Patients have asthenia, weight loss, mucosal bleeding, lymph node enlargement, splenomegaly and neurological changes resulting from hyperviscosity and/or cytopenias. Treatment goal is to relieve symptoms. Recently, targeted drugs have been used, which may increase its median overall survival in the next years. Notwithstanding these drugs are not equally available around the world. Objective: To recognize clinical, epidemiological profile and treatment evaluation of WM patients at Santa Casa de Sao Paulo, Brazil. Design: WM retrospective analysis cohort diagnosed between January 1, 2000 and December 31, 2016. Patients or other participants: We analyzed patients with WM diagnosis. HIV, HBV, and HCV positive serology patients were excluded. Results: There were 18 patients, 10 men/8 women, with 61 years old median age. Fifteen patients presented with splenomegaly; 14 had B symptoms at diagnosis. Median serum IgM was 3019 mg/dL; 8 patients were submitted to plasmapheresis because of symptomatic hyperviscosity syndrome. 70% were classified as High/Very-high risk and all patients were treated upfront. As 1st line treatment we used alkylant + prednisone in 12 patients; alkylant + prednisone + anthracycline in 3 patients; fludarabine in 2 patients and to 1 patient only prednisone. Less than 25% got CR/VGPR; 5.5% got PR and 72% were refractory. There were 2 deaths before 2nd line treatment for which we used fludarabine-based therapy in 9, alkylant + prednisone + anthracycline in 2 and alkylant + prednisone in 1 patient. Ten patients were dead before 3rd line therapy. Mean OS was 55 months. Hb under 9.5 g/dl and platelets under 120×103mm3 had statistically significant worse median OS. Conclusions: Our Waldenstrom macroglobulinemia cohort showed poor response to 1st line chemotherapy regimens. IPSS-WM showed that they arrive in severe clinical conditions making it a challenging treatment. The absence of new available target drugs might have resulted in bad 1st line response and a high relapse rate.

ABCL-017: Diffuse Large B-Cell Lymphoma in Very Elderly Patients at Santa Casa de Sao Paulo, Brazil: A Clinical Analysis in a Single Center

<h3>Context:</h3> Diffuse large B cell lymphoma (DLBCL) is non-Hodgkin lymphoma's most common histological subtype. It has a slight predominance in men, around 65 years old median age, but an age-increasing prevalence. Although R-CHOP (rituximab associated to cyclophosphamide, doxorubicin, vincristine and prednisone) is considered its standard treatment, studies generally exclude patients over 80 years old due to their clinical conditions. This results in a lack of scientific data for best therapeutic management to this group of patients. <h3>Objective:</h3> To evaluate clinical, laboratory and therapeutic profile of DLBCL patients aged equal to or over 80 years old treated at Santa Casa hospital in Sao Paulo, Brazil between January 1, 2013, and December 31, 2017. <h3>Design:</h3> Retrospective, cross-sectional cohort study of DLBCL patients diagnosed with 80 years old or older treated at Santa Casa hospital in Sao Paulo, Brazil from January 1, 2013 to December 31, 2017. We analyzed their clinical, laboratory and therapeutic data. <h3>Patients or other participants:</h3> We analyzed 13 patients with DLBCL diagnosed between January,2013 and December 2017. HIV, HBC, and HCV positive serology patients were excluded. <h3>Results:</h3> We analyzed 13 patients with 83 years old median age, predominantly female (M / F ratio 1.0 / 2.25). More than 90% had some previous comorbidity; cardiovascular and endocrine-metabolic diseases were the most prevalent. At diagnosis, 61.5% had constitutional symptoms and 46.2% had Ann Arbor advanced staging. Concerning laboratory data at diagnosis, 46.2% were anemic, 15.4% were plaquetopenic, 23.1% were lymphopenic and 69.3% were hypoalbuminemic. According to Hans' criteria, 53,8% were non-GCB DLBCL. In prognostic evaluation according to the R-IPI and NCCN-IPI respectively 46.1% were intermediate-risk and 61.5% high-risk, respectively. R-mini-CHOP was more frequently used for treatment (38.5%) followed by R-CHOP. About 60% of patients who underwent chemotherapy completed treatment initially proposed. The median overall survival (SG) was 118 days and 84.6% died, almost 40% by sepsis. Patients with high serum albumin values and higher hemoglobin values had a statistically significant better OS (p = 0.020). <h3>Conclusions:</h3> DLBCL in very elderly patients is an orphan clinical situation. It has some relevant characteristics that must be taken into account to offer more adequate and safer therapy.

THU374 - Why didn’t I see you in my clinic? Patients with HCV positive serology but never a confirmed infection. A retrospective analysis at 10 years

THU374 - Why didn’t I see you in my clinic? Patients with HCV positive serology but never a confirmed infection. A retrospective analysis at 10 years

Factors associated with psoriasis in a French Nationwide HIV cohort: the independent role of HLA-B*57:01.

Psoriasis is a T-cell-mediated inflammatory disease with genetic factors involved in its etiopathogenesis. In non-HIV populations, HLA-B57:01 has been associated with a higher risk of psoriasis. The aim of this study was to investigate demographic and immunovirological characteristics associated with psoriasis, and to assess whether HLA-B57:01 is associated with psoriasis among people living with HIV (PLHIV) followed in a large French multicenter Dat'AIDS cohort. All PLHIV followed up from January 2000 to December 2018 with an available result for HLA-B57:01 were included. Logistic regression models were used to identify associations between psoriasis (outcome variable) and explanatory variables. Among 31 076 PLHIV, the overall prevalence of psoriasis and HLA-B57:01 were 2.25 and 4.73%, respectively and varied according to ethnicity. By multivariate analysis, male gender [OR 1.81 (95% CI 1.46-2.24), P < 10], positive HLA-B57:01 [OR 2.66 (95% CI 2.12-3.33), P < 10], nadir CD4 cell count less than 200 cells/μl [OR 1.41 (95% CI 1.19-1.67), P < 10] and positive HCV serology [OR 1.45 (95% CI 1.20-1.76), P < 10] were significantly associated with a higher risk of psoriasis. Being born in West and Central Africa [OR 0.15 (95% CI 0.10-0.25), P < 10], the Caribbean islands [OR 0.14 (95% CI 0.05-0.45), P = 0.0008] or Latin America [OR 0.31 (95% CI 0.14-0.69), P = 0.004] was associated with a lower risk of psoriasis compared with patients born in mainland France. PLHIV carrying HLA-B57:01 have around a three-fold increased risk of psoriasis. This association might provide a possible explanation for the observed differences in psoriasis prevalence between ethnic groups.

RISK OF TYPE 2 DIABETES MELLITUS IN PATIENTS WITH HEPATITIS C INFECTION.

The objective of this study is to Hepatitis C Infection patients leads to type2 diabetes mellitus. Study Design: Cross sectional study. Setting: Civil hospital, Karachi.Period: June 2017 to February 2018. Materials and Methods: We screened 1941 patientsand out of them 328 patients had HCV positive serology. HCV serology status was assessedby checking for HCV antibody. To evaluate incidence of type 2 diabetes mellitus in patients withHCV seropositivity, blood glucose levels of all patients were performed. Patients with cirrhosis,pancreatitis, co-existent hepatitis B and any other co-morbid. According to new diagnosticcriteria by WHO hyperglycaemia is labelled at blood glucose levels of 200mg/dl. Results: Wefound total 328 cases showing HCV seropositivity out of total 1941 patients visiting the outpatientdepartment. There were 213 males and 115 females in the data. The demographic data ofpatients suggests that 53% patients lived in rural areas whereas 47% had their residence inurban areas. This suggests that patients living in rural areas having slightly higher prevalence ofhepatitis C than those in urban areas It suggests that age group 30-40 had highest prevalenceof hepatitis C and age 50-60 had lowest prevalence of hepatitis C. Out of 328, 36% (n=118)patients had developed diabetes mellitus. The viral load of patients was also performed, andit was found to be in the range of 1567 to 8706576 IU/ml in males. In females it was 1340 to6890042IU/ml. The results revealed that males have higher viral load than females. Conclusion:In patients with HCV infection, there is increased risk of development of type 2 diabetes mellitus.Glucose metabolism abnormalities start a lot earlier than systemic manifestations of hepatitisC. So, blood glucose levels should be regularly checked to prevent complications. Hepatitis Cshould be treated at its earliest to help patients achieve improved glycaemic control.

Seroprevalence and Molecular Biodiverisity of Hepatitis C Infection in Congolese Diabetics

Summary: There is no evidence for comorbidity diabetes and hepatitis C virus infection in the Congo. The aim of this work was to determine the seroprevalence and molecular biodiversity of HCV in order to contribute to improving the management of Congolese diabetics. Patients and methods: It was a cross-sectional study that took place from 1 February to 30 September 2018 at the Brazzaville University Hospital, the Diabcare Health Center and the Adolphe Cisse Hospital in Pointe-Noire. It concerned diabetic patients followed in Brazzaville and Pointe-Noire agreeing to the study, after obtaining the opinion of the ethics committee of the research in health science. All samples collected were screened for the presence of anti HCV Ab using a rapid ALERE HCV test and the Monolisa HCV Ag-Ab ultra test for confirmation in Congo. Detection of the viral RNA was done by PCR retrotranscription and genotyping was performed according to the reverse hybridization technique in France. Data analysis was done with EpiInfo 6.0 software (2016); the proportions were compared using the Chi-square test or the Fisher test at the significance level of 5%. Results: Of 447 patients with diabetes mellitus, 49 had HCV positive serology and the sex ratio was 0.63. Seroprevalence of AC anti HCV was 11% (49/447); HCV RNA was detectable in 71.4% (n = 35) patients. The average age of the population was 62 ± 10 years with extremes ranging from 26 to 82 years. The circulating genotypes were 4 (97.1%) and 1 (2.8%). Subtyping was defined in 17.64% (n = 6) of genotype 4 patients; undefined in 82.36% (n = 28) of Genotype 4 patients, and in one of genotype 1 patients. The subtypes identified were subtype 4e (60%), subtype 4e (8.8%), subtype 4a/4c/4d (5.8%), and subtype 4h (2.9%). Conclusion: The prevalence of HCV is high in our study. These are important data for the improvement of the management of diabetics.

2218. Low Hepatitis C Treatment Rates Among Patients Screened as Inpatients at a Rural Academic Medical Center

BackgroundThe rise in injection drug use in the rural United States has led to an increase in admissions for injection-related conditions. Hepatitis C (HCV) infection is prevalent amongst people who inject drugs and might be diagnosed during such episodes of acute care. Linkage to care and initiation of treatment for hepatitis C in this group has been difficult, especially in rural settings lacking comprehensive care for people with substance use disorder (SUD).MethodsWe reviewed the charts of patients admitted to an inpatient service at Dartmouth-Hitchcock Medical Center (DHMC) who had positive HCV serology in 2016. We determined the proportion of patients who had follow-up testing for HCV RNA, were referred, followed up and initiated treatment for HCV by the end of 2017.ResultsIn 2016, 504 inpatients at DHMC were screened with an HCV antibody test, of which 65 (13%) were positive. Of these, 50 (77%) had follow-up HCV RNA testing, resulting in 38 (76%) patients with detectable viremia. Of the 53 patients with detected (38) or unknown viremia (15), five died on the index admission, one was discharged to a hospice, 16 were referred to the DHMC hepatology (GI) clinic and 11 to the DHMC infectious disease (ID) clinic, but 20 received no referral. Thirty-two (60%) patients had an active SUD, and 7 (13%) were in remission.Through December 31, 2017, 15 (31%) of the surviving 48 patients had no further follow-up in the Dartmouth-Hitchcock Health System. Fourteen (29%) patients followed up in the GI clinic, 11 (23%) followed up in the ID clinic and 8 (17%) had subsequent encounters in clinics for conditions other than HCV. Only 5 (10%) patients were treated for HCV and achieved sustained virologic response (SVR), all of which had followed up in the GI clinic. The odds of follow-up or treatment were independent of a history of SUD. Providers frequently deferred treatment due to ongoing substance use or a focus on more urgent medical issues. Insurance coverage for direct-acting antivirals was evolving during the study period, preventing treatment in some patients.ConclusionOnly 10% of patients screened positive for HCV during an inpatient admission to a rural academic medical center received treatment for HCV in the year following their diagnosis. Linkage to care, patient engagement and provider perceptions have to improve to achieve elimination of HCV.Disclosures All authors: No reported disclosures.

Factors associated with deaths from suicide in a French nationwide HIV-infected cohort.

People living with HIV (PLHIV) are at a higher risk of dying by suicide than the general population. Epidemiological data regarding determinants of suicide in PLHIV are scarce. The aim of this study was thus to study demographic, socio-economic, psychiatric history and immunovirological characteristics associated with death from suicide in the French multicenter Dat'AIDS cohort, from January 2000 to July 2013. This was a nested case-control study. All deceased PLHIV during the study period who died by suicide and whose medical files could be checked were included as cases. Controls were selected using incidence density sampling. For each case, up to four controls were selected among all actively followed PLHIV at the index date (date of death of cases). Controls were matched for time from HIV diagnosis (5-year periods) and clinical centre. Seventy cases and 279 controls were included in the study. By multivariable analysis, the factors significantly associated with death from suicide were: not having children, active or substituted drug consumption, alcohol intake > 20 g/day or history of alcohol abuse, history of depressive disorder and/or of attempted suicide, and psychotropic drug intake. Conversely, age, gender, country of birth, positive HCV serology and HIV-related factors, such as AIDS status, use of combination antiretroviral therapy (cART), nadir and current CD4 counts and HIV viral load, were not significantly associated with the risk of death from suicide. In the cART era, HIV-related factors are not associated with a higher risk of suicide mortality. Suicide prevention measures should target PLHIV with the psychological morbidities observed in our cohort.

Effect of conversion from calcineurin inhibitors to everolimus on hepatitis C viremia in adult kidney transplant recipients.

ABSTRACTIntroduction:Currently, there is no specific immunosuppressive protocol for hepatitis C (HCV)-positive renal transplants recipients. Thus, the aim of this study was to evaluate the conversion effect to everolimus (EVR) on HCV in adult kidney recipients.Method:This is an exploratory single-center, prospective, randomized, open label controlled trial with renal allograft recipients with HCV-positive serology. Participants were randomized for conversion to EVR or maintenance of calcineurin inhibitors.Results:Thirty patients were randomized and 28 were followed-up for 12 months (conversion group, Group 1 =15 and control group, Group 2 =13). RT-PCR HCV levels reported in log values were comparable in both groups and among patients in the same group. The statistical analysis showed no interaction effect between time and group (p value G*M= 0.852), overtime intra-groups (p-value M=0.889) and between group (p-value G=0.286). Group 1 showed a higher incidence of dyslipidemia (p=0.03) and proteinuria events (p=0.01), while no difference was observed in the incidence of anemia (p=0.17), new onset of post-transplant diabetes mellitus (p=1.00) or urinary tract infection (p=0.60). The mean eGFR was similar in both groups.Conclusion:Our study did not show viral load decrease after conversion to EVR with maintenance of antiproliferative therapy.

Gemcitabine plus platinum-based chemotherapy for first-line treatment of hepatocholangiocarcinoma: an AGEO French multicentre retrospective study

Background:Hepatocholangiocarcinoma (cHCC-ICC) is a rare liver tumour for which no data on chemosensitivity exist. The aims of this multicentre study were to evaluate overall survival (OS), progression-free survival (PFS), and prognostic factors in cHCC-ICC treated by gemcitabine plus platinum as first-line.Methods:Unresectable cHCC-ICC treated by gemcitabine plus platinum-based chemotherapy between 2008 and 2017 were retrospectively analysed. Diagnosis was based on histology or, in case of ICC or HCC histology, on discordant computerised tomography scan enhancement patterns associated with discordant serum tumour marker elevation suggesting the alternative tumour. OS and PFS were evaluated by Kaplan–Meier method and prognostic factors by Log-rank test and Cox model.Results:Among 30 patients included, cHCC-ICC was histologically proven in 22 (73.3%). 18 (60%) received gemcitabine plus oxaliplatin (GEMOX), 9 (30%) GEMOX plus bevacizumab, and 3 (10%) gemcitabine plus cisplatin. RECIST criteria were reported in 28 patients: 8 (28.6%) showed partial response, 14 (50%) stable disease, and 6 (21.4%) tumour progression at first evaluation. Median PFS and OS were 9.0 and 16.2 months, respectively. Serum bilirubin ⩾30 μmol l−1 (P=0.001) and positive serology for HBV and/or HCV (P=0.014) were independent poor prognostic factors for OS.Conclusions:Gemcitabine plus platinum-based chemotherapy is effective as first-line for advanced cHCC-ICC.