Hepatitis C Virus Viremia Research Articles

Hepatitis C virus-related complications are increasing in women veterans: A national cohort study.

There are gender-specific variations in the epidemiology and clinical course of hepatitis C virus (HCV) infection. However, few long-term longitudinal studies have examined trends in the incidence and prevalence of serious liver complications among women compared with men with HCV infection. We used the Veterans Administration Corporate Data Warehouse to identify all veterans with positive HCV viraemia from January 2000 to December 2013. We calculated gender-specific annual incidence and prevalence rates of cirrhosis, decompensated cirrhosis and hepatocellular cancer (HCC) adjusting for age, diabetes, HIV and alcohol use. We also calculated the average annual per cent change (AAPC) for each outcome by gender using piecewise linear regression in the Joinpoint software. We identified 264409 HCV-infected veterans during 2000-2013, of whom 7162 (2.7%) were women. There were statistically significant increases over time in the incidence rates of cirrhosis, decompensated cirrhosis and HCC for both men and women. The annual-adjusted incidence rates of cirrhosis, decompensated cirrhosis and HCC were higher in men than women for all study years. However, these complications increased at a similar rate in both groups. Specifically, the AAPC for cirrhosis was 13.1 and 15.2, while it was 15.6 and 16.9 for decompensated cirrhosis and 21.0 and 25.3 for HCC in men and women, respectively (all test of parallelism not significant). The results were similar in the prevalence analyses, although AAPCs were slightly smaller for each outcome. In conclusion, we found an ongoing upward trend in the incidence and prevalence of HCV complications in this cohort of HCV-infected women. This increase in cirrhosis complications in women with active HCV infection is similar to those in men. With cure from HCV now becoming a reality, most of the projected burden of HCV is potentially preventable. However, benefits of HCV treatment will need to extend to all patients in order to stem the rising tide of HCV complications.

Rational Heart Transplant From a Hepatitis C Donor: New Antiviral Weapons Conquer the Trojan Horse

BackgroundDonors with hepatitis C (HCV) viremia are rarely used for orthotopic heart transplantation (HT) owing to post-transplantation risks. New highly effective HCV antivirals may alter the landscape. MethodsAn adult patient unsuitable for bridging mechanical support therapy accepted a heart transplant offer from a donor with HCV viremia. On daily logarithmic rise in HCV viral load and adequate titers to ensure successful genotyping, once daily sofosbuvir (400 mg)–velpatasvir (100 mg) (Epclusa; Gilead) was initiated empirically pending HCV genotype (genotype 3a confirmed after initiation of therapy). ResultsWe report the kinetics of acute hepatitis C viremia and therapeutic response to treatment with a new pangenotypic antiviral agent after donor-derived acute HCV infection transmitted incidentally with successful cardiac transplantation to an HCV-negative recipient. Prompt resolution of viremia was noted by the 1st week of a 12 week course of antiviral therapy. Sustained virologic remission continued beyond 12 weeks after completion of HCV therapy (SVR-12). ConclusionsThe availability of effective pangenotypic therapy for HCV may expand donor availability. The feasibility of early versus late treatment of HCV remains to be determined through formalized protocols. We hypothesize pharmacoeconomics to be the greatest limitation to widespread availability of this promising tool.

Early Outcomes Using Hepatitis C-Positive Donors for Cardiac Transplantation in the Era of Effective Direct-Acting Antiviral Treatments

Introduction: The shortage of suitable donor hearts for cardiac transplantation contributes to wait list mortality. Given this need, and the favorable drug profiles and efficacy of current agents used to treat Hepatitis C (HCV), our institution recently piloted transplantation of selected patients using HCV-positive donors. Methods: Between September 2016 and March 2017, 11 HCV-naïve patients and 1 patient with a history of HCV that was treated and cured prior to listing, underwent heart transplantation from HCV-positive donors. Patients were treated per our standard immunosuppression protocol. Following transplant, patients were referred to hepatology for monitoring and treatment. Data collection and analysis were performed after obtaining informed patient consent and IRB approval. Results: Baseline characteristics: Mean age of recipients at time of transplant was 52.7 years (SD 9.9). Eight patients (66%) were male, eight patients (66%) were Caucasian, and eight patients (66%) were on left ventricular assist device support. Mean age of organ donors was 30.3 years (SD 4.3). All donors tested positive for antibodies to HCV; only ten had positive HCV nucleic acid testing. Time to transplant: Recipients' total wait list time varied prior to them consenting to receive an HCV-positive heart. Following consent, time to transplant was short (median 2.5 days [IQR 1.2–17]), even for patients with unfavorable blood groups, elevated panel reactive antibodies, or lower listing status. Hepatitis C testing and treatment: Nine of 12 patients (75%) who received hearts from HCV-positive donors developed HCV viremia. Three patients remain disease-free. Of the nine patients who developed HCV, seven patients have initiated or completed antiviral treatment, with a fixed dose combination of either sofosbuvir/ledipasvir or sofosbuvir/velpatasvir. All treated patients have undetectable viral loads (mean time from treatment initiation to viral suppression 53.3 days [SD 28.8]). The two remaining patients with HCV will soon initiate treatment. Tolerability and adverse events: Among patients who initiated HCV treatment and demonstrated suppression of viremia, one patient died due to a pulmonary embolism and one patient developed echocardiographic graft dysfunction of unclear etiology, which resolved spontaneously upon subsequent imaging. Conclusions: In the era of highly effective HCV pharmacotherapy, the use of HCV-positive donors represents a potential approach to safely expand the donor pool. This report represents the first and largest series to date and demonstrates that HCV treatment leads to rapid viral suppression early after transplant, despite immunosuppression. Additional follow-up is needed to elucidate long-term outcomes and assess for sustained virologic response.

Tree shrew, a potential animal model for hepatitis C, supports the infection and replication of HCV in vitro and in vivo.

The tree shrew (Tupaia belangeri chinensis), a small animal widely distributed in Southeast Asia and southwest China, has the potential to be developed as an animal model for hepatitis C. To determine the susceptibility of the tree shrew to hepatitis C virus (HCV) infection in vitro and in vivo, a well-established HCV, produced from the J6/JFH1-Huh7.5.1 culture system, was used to infect cultured primary tupaia hepatocytes (PTHs) and tree shrews. The in vitro results showed that HCV genomic RNA and HCV-specific nonstructural protein 5A (NS5A) could be detected in the PTH cell culture from days 3–15 post-infection, although the viral load was lower than that observed in Huh7.5.1 cell culture. The occurrence of five sense mutations [S391A, G397A, L402F and M405T in the hypervariable region 1 (HVR1) of envelope glycoprotein 2 and I2750M in NS5B] suggested that HCV undergoes genetic evolution during culture. Fourteen of the 30 experimental tree shrews (46.7 %) were found to be infected, although the HCV viremia was intermittent in vivo. A positive test for HCV RNA in liver tissue provided stronger evidence for HCV infection and replication in tree shrews. The results of an immunohistochemistry assay also demonstrated the presence of four HCV-specific proteins (Core, E2, NS3/4 and NS5A) in the hepatocytes of infected tree shrews. The pathological changes observed in the liver tissue of infected tree shrews could be considered to be representative symptoms of mild hepatitis. These results revealed that the tree shrew can be used as an animal model supporting the infection and replication of HCV in vitro and in vivo.

Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program.

Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCV would also facilitate referrals to newly available curative HCV treatments following delivery.

Reversion of anergy signatures in clonal CD21low B cells of mixed cryoglobulinemia after clearance of HCV viremia

AbstractHepatitis C virus (HCV) causes mixed cryoglobulinemia (MC) by driving clonal expansion of IgM+CD27+ B cells. These cells display both the features of anergy induced by continual engagement of the B-cell receptor (BCR), such as high expression of phosphorylated extracellular signal–regulated kinase (pERK) and reduced lifespan, and of virus-specific exhaustion, such as CD21low phenotype and a defective response to ligation of BCR and Toll-like receptor 9 (TLR9). MC usually regresses after eradication of HCV with interferon, whose immunomodulatory activity might contribute to this effect. We investigated the phenotypic and functional changes in clonal B cells of MC patients with sustained virologic responses to direct-acting antivirals (DAAs), which lack immunomodulatory properties. We found that high pERK expression and accelerated apoptosis revert within 4 weeks after beginning therapy, whereas clonal B cells unresponsive to TLR9 stimulation persist for at least 24 weeks, although they may partially rescue normal CD21 expression. Thus, similar to mouse models, features of anergy in MC B cells rapidly revert after disengagement from HCV, whereas virus-specific exhaustion imparts a durable inhibitory imprint on cell function. Treatment of HCV+ MC with DAAs provides a valuable tool for untangling the molecular mechanisms of anergy and exhaustion in human B cells.

Favouring modulation of circulating lipoproteins and lipid loading capacity by direct antiviral agents grazoprevir/elbasvir or ledipasvir/sofosbuvir treatment against chronic HCV infection

ObjectiveLipid homoeostasis is disturbed in patients with HCV infection. Direct-acting antiviral agent (DAA) treatment eradicates chronic HCV viraemia, but the dynamics of lipid components remain elusive. This study investigates the...

Up-regulation of circulating miRNA146a correlates with viral load via IRAK1 and TRAF6 in hepatitis C virus-infected patients

BackgroundHepatitis C virus (HCV) is a life threatening human pathogen. It has been found that miRNA146a regulates innate immunity, inflammatory response and antiviral pathway.We evaluated miRNA146a expression by real-time PCR and IL-1 receptor associated kinase 1 (IRAK1) and TNF receptor-associated factor 6 (TRAF6) levels by ELISA in serum of 36 HCV viremia patients and 42 age and gender matched healthy controls. ResultsmiRNA146a expression was significantly higher in HCV patients with a best cut off value 1.63 to discriminate between HCV patients and healthy controls. Meanwhile, it was negatively correlated to IRAK1 and TRAF6 levels and positively correlated to viral load in HCV patients. ConclusionsmiRNA146a has a potential role in HCV infection and viral replication through IRAK1 and TRAF6. It can also serve as a new screening method for HCV.

Improving the outcomes of human immunodeficiency virus/hepatitis C virus–coinfected transplant recipients: The answer is Blowin’ in the wind

Improving the outcomes of human immunodeficiency virus/hepatitis C virus–coinfected transplant recipients: The answer is Blowin’ in the wind

HCV viraemia associates with NK cell activation and dysfunction in antiretroviral therapy-treated HIV/HCV-co-infected subjects.

The impact of hepatitis C virus (HCV) RNA levels on immune status in chronically HCV mono-infected when compared to HIV/HCV co-infected on antiretroviral therapy (ART) remains poorly understood. A total of 78 African American subjects HCV viraemic/naïve to HCV treatment (33 HCV genotype 1 mono-infected, 45 ART-treated HIV/HCV genotype 1 co-infected) were studied. Clinical and liver enzyme measurements were performed. Whole blood was analysed for immune subset changes by flow cytometry. Peripheral blood mononuclear cells (PBMC) were used for same-day constitutive and in vitro Interferon (IFN)-α-induced signal transducer and activator of transcription (STAT) phosphorylation, K562 target cell lysis and K562 target cell recognition-mediated IFN-γ production. Statistical analysis was performed using R (2.5.1) or JMP Pro 11. While both groups did not differ in the level of liver enzymes, HIV/HCV had higher T-cell activation/exhaustion, and constitutive STAT-1 phosphorylation compared to HCV. In contrast, CD4+ FoxP3+ CD25+ frequency, IFN-αR expression on NK cells, as well as constitutive and IFN-α-induced direct cytotoxicity were lower in HIV/HCV. Linear regression models further supported these results. Finally, increase in HCV viral load and CD4+ T-cell count had an opposite effect between the two groups on NK cell activity and T-cell activation, respectively. HCV viral load in ART-treated HIV/HCV co-infection was associated with greater immune activation/exhaustion and NK dysfunction than HCV viral load alone in HCV mono-infection. The more pronounced immune modulation noted in ART-treated HIV-co-infected/untreated HCV viraemic subjects may impact HCV disease progression and/or response to immunotherapy.

Prevalence of hepatitis C virus in adult population in the Czech Republic - time for birth cohort screening.

Chronic hepatitis C is curable disease. Low detection rate could be one of the reasons of poor treatment uptake. It is important to identify HCV prevalence and anti-hepatitis C virus (HCV) positive patients in population by effective screening strategy such as risk-based or birth cohort screening programs. There are no national population-based estimates of the HCV prevalence in the Czech Republic (CZ). The most recent seroprevalence survey determined a prevalence of positive anti-HCV antibodies of 0.2% (in 2001). The aim of the study was to determine the seroprevalence of HCV, HCV viraemia and HCV genotype in the CZ adult population. We also estimated the number of persons living with chronic hepatitis C in CZ. The examined group included 3000 adults, 18–90 years of age enrolled in 2015. All serum samples were examined to determined anti-HCV antibodies positivity, HCV-RNA positivity and genotypes. Of the 3000 samples, 50 were found to be anti-HCV-positive, for a seroprevalence of 1.67% (2.39% in males, 0.98% in females). The overall prevalence of positive HCV RNA was 0.93%: 1.5% in males, 0.39% in females. HCV genotype (GT) 1a was determined in 25%, GT 1b in 25% and GT 3a in 46%. Since 2001, the HCV seroprevalence has increased 8-fold. The highest HCV seroprevalence occurred in males aged 30–44 years. We can estimate that there are more than 140,000 people with HCV antibodies and more than 80,000 people with chronic hepatitis C living in the CZ. The introduction of birth cohort HCV screening could be beneficial for the country.

Engagement in Care of High-Risk Hepatitis C Patients with Interferon-Free Direct-Acting Antiviral Therapies.

The extent to which hepatitis C (HCV) treatment uptake is improved following introduction of interferon-free direct-acting antiviral (DAA) treatments is unknown. The purpose of this study was to determine HCV patient engagement and barriers to care for accessing DAA treatments in a real-world setting. Patients with HCV viremia at high risk for fibrosis were identified using the Veterans Affairs (VA) registry within San Diego's VA in October 2014. Patients not enrolled in HCV clinic were systematically contacted by letter and phone. Logistic regression was used to examine patient factors associated with subsequent engagement in care over 12-20months. In the local registry of 2089 patients, 481 were identified with high-risk fibrosis scores. Of those, 380 (79%) were eligible for antiviral treatment, and 178/380 (47%) patients were actively followed in clinic. The remaining 202/380 (53%) patients were never seen by a HCV clinic provider or lost to follow-up. Of these, 114/380 (30%) of the treatment-eligible cohort remained non-engaged in care following outreach. Compared with patients engaged in care, non-engaged patients were significantly more likely to have homelessness, COPD comorbidity, or active alcohol or/and drug use. Overall 74.4% of patients engaged in HCV clinic received antiviral treatment. A significant portion of eligible HCV patients could not be engaged in treatment after a programmatic outreach effort. These data indicate that more sustained or innovative outreach efforts are needed in order to maximize treatment access, with specific interventions targeting those with unstable housing and active alcohol/substance use disorders.

1057 - Hepatitis C virus Antigens Enzyme Immunoassay (HCV-AGS EIA) for One-Step Diagnosis of Viremic HCV Co-Infection in HIV Infected Individuals

1057 - Hepatitis C virus Antigens Enzyme Immunoassay (HCV-AGS EIA) for One-Step Diagnosis of Viremic HCV Co-Infection in HIV Infected Individuals

Impact of HCV Viremia on Acute Rejection Events Post Kidney Transplant

Impact of HCV Viremia on Acute Rejection Events Post Kidney Transplant

HCV core-antigen assay as an alternative to HCV RNA quantification: A correlation study for the assessment of HCV viremia

IntroductionDetection of hepatitis C virus (HCV) RNA and the HCV core antigen assay (HCV-Ag) are reliable techniques for the diagnosis of active and chronic HCV infection. Our aim was to evaluate the HCV-Ag assay as an alternative to quantification of HVC RNA. MethodsA comparison was made of the sensitivity and specificity of an HCV-Ag assay (204 serum samples) with those of a PCR assay, and the correlation between the two techniques was determined. ResultsThe sensitivity and specificity of HCV-Ag was 76.6% and 100%, respectively. Both assays were extremely well correlated (Pearson coefficient=0.951). The formula (LogCV=1.15*LogAg+2.26) was obtained to calculate the viral load by PCR from HCV-Ag values. HCV-Ag was unable to detect viral loads below 5000IU/mL. ConclusionAlthough the HCV-Ag assay was less sensitive than the PCR assay, the correlation between both assays was excellent. HCV-Ag can be useful as a first step in the diagnosis of acute or chronic HCV infection and in emergency situations.

Persistent neuropsychiatric impairment in HCV patients despite clearance of the virus?!

One of the most disabling symptoms of hepatitis C virus (HCV) infection is chronic fatigue. While this is accepted for HCV polymerase chain reaction (PCR)-positive patients, a relationship between HCV infection and chronic fatigue is questioned after successful virus eradication. As fatigue is a subjective criterion, we aimed to evaluate in addition mood alterations and cognitive function in HCV-exposed patients with only mild liver disease and to assess a) possible interrelationships between these factors and health-related quality of life and b) the impact of viremia and former interferon treatment. One hundred and fifty-nine anti-HCV-positive individuals without advanced liver disease answered health-related quality of life (HRQoL), fatigue and depression questionnaires and underwent a battery of attention and memory tests. Accompanying diseases which could distort the results of the study such as HIV co-infection or drug addiction were exclusion criteria. The patients were subdivided into four groups according to their viremia status and interferon treatment history. Patients' data were evaluated with respect to norms given in the respective test manuals and in addition compared to those of 33 age-matched healthy controls. Eighty-five per cent of the patients had chronic fatigue, 50-60% mild depression or anxiety, 45% memory deficits and 30% attention deficits, irrespective of their HCV viremia status or treatment history. HRQoL correlated negatively with chronic fatigue (P<.001), while cognitive deficits-especially memory function-were independent from fatigue and depression. HCV infection may cause long-standing cerebral dysfunction that significantly impairs HRQoL and may even persist after clearance of the virus.

Real World Experience of Sofosbuvir/Ledipasvir Therapy in HIV Patients Co-infected with HCV: A Retrospective Study

BackgroundDirect acting antiretrovirals in clinical trials have high efficacy achieving sustained virologic response (SVR) in Hepatitis C virus (HCV) and human-immunodeficiency virus (HIV) co-infected patients. We aim to investigate real-world HCV SVR outcome of ledipasvir/sofosbuvir therapy in the HIV population.MethodsWe performed a retrospective chart review from 2014 to 2016 of patients with HCV/HIV coinfection who received ledipasvir/sofosbuvir in a freestanding HIV clinic. Demographic data collected includes: HCV genotype (Gt), Fib-4 score, length of therapy (LOT), HIV viral load (VL), CD4+ cell count, antiretroviral therapy (ART), HCV RNA levels at baseline, 4 weeks, 8 weeks, end of therapy (EOT), and SVR at week 12 post-treatment. Statistical analysis was performed using Stata version 14 (STATA Corp., Texas, USA).ResultsA total of 94 patients were included. The mean age was 54 years-old, 78% were male. Most patients (95%) had Gt 1 HCV infection (84% 1A, 11% 1B and 1% mixed), 4% Gt 4, and one patient had Gt 6; 24% of patients had compensated cirrhosis.Median LOT was 12 weeks. 95% of patients received 12 weeks, 4% 24 weeks, and 1% received 16 weeks of therapy. Most patients had undetectable HIV VL (77% with <20 copies/mL), while 23% had HIV VL range from 20 to 1,430 copies/mL. The mean CD4+ count was 639 cells/microliters (95% CI 567–711). The most commonly used ARTs were efavirenz/emtricitabine/tenofovir (21%), followed by abacavir/dolutegravir/lamivudine (15%). SVR12 was achieved in 99% (93/94) of patients (100% in HCV treatment experienced). Of those patients, 86/91 achieved HCV VL <15 at week 4 and 80/82 at EOT. The mean Fib-4 score at start of therapy was 2.33 with post-therapy of 1.35. One patient (Gt 1A, F4, on FTC/TDF/RAL) failed therapy secondary to NS5a mutation (L31M/V) and was retreated with sofosubuvir/simeprevir for 12 weeks achieving SVR 12. Interestingly, 4 patients had undetectable HCV VL at EOT with post-EOT HCV viremia (157–4511 IU/mL) that resolved on its own on repeated testing.ConclusionOur HCV real-life experience with ledipasvir/sofosbuvir at a freestanding HIV clinic confirms the efficacy and safety reported in randomized clinical trials. NS5A mutation led to treatment failure in this heterogeneous group of patients.Disclosures All authors: No reported disclosures.

Nosocomial hepatitis C infection among hemodialysis patients: a single center study in Assuit University Hospital

Background There is an increased risk of acquiring hepatitis C virus (HCV) infection among hemodialysis (HD) patients. HCV prevalence varies considerably among different HD centers throughout the world. In Egypt, the prevalence of HCV in HD patients could reach 50.7%. Aim The aim of this study were to measure the rate of HCV seroconversion for patients at the HD Unit in Assiut University Hospitals and to assess the diagnostic utility of routine laboratory test of anti-HCV antibodies used in those patients. Patients and methods This study was performed at the HD Unit, in the Internal Medicine Department, Assiut University Hospital. We included patients on regular HD between 2011 and 2014 who were negative for anti-HCV and hepatitis B surface antigen with normal liver enzyme level. Follow up after 3 and 6 months was done by testing for liver enzymes and anti-HCV using third-generation enzyme-linked immunosorbent assay and cases with positive results had qualitative real-time PCR to confirm the result. Results We recruited 63 patients, seroconversion for anti-HCV was found in 21 (33.3%) patients; seven patients develop this seroconversion after 3 months follow-up transiently and 14 patients develop it after 6 months follow-up. However, all patients lack HCV viremia as confirmed by testing for HCV RNA using real-time PCR. Conclusion In our study, seroconversion for anti HCV among the HD patients was found in 33.3% but they lack HCV viremia. Screening in HD units is better to be done using PCR testing to avoid transient anti HCV seroconversion particularly in units with high prevalence of anti HCV.

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

INTRODUCTION: There is considerable uncertainty with respect to predicting the liver disease status of African American (AA) patients with Hepatitis C seen in the current era of highly effective direct acting anti-virals (DAA). This uncertainty is due to the complex interplay between the identification of patients early in their disease progression by screening, the fact that many AA patients failed earlier interferon based therapy, duration of the HCV viremia in AA patients, the possible variation In disease course in AA as compared to other races, and potential early mortality of AA patients due to liver disease. Understanding the evolution of HCV infection as defined by comparing previous and current patient populations provides information relevant to both therapeutic and health costs decisions. METHODS: We selected patients from a 24 month period between 2002 and 2003 (Epoch 1; n = 414) to compare with patients seen in the same GI clinic between 2012 and 2013 (Epoch 2; n=405). Epoch 1 was the beginning of the peg-interferon and ribavirin treatment era and Epoch 2 reflects the patient population seen when DAA therapy was first available. RESULTS: Epoch 2 patients were older (59.7 vs 50.3 years) with a similar gender distribution (55% vs 59% male). Consistent with the change in clinic demographics, more AA patients were seen in Epoch 2 (89%) as compared to Epoch 1 (77%). There was no significant difference between hepatic fibrosis as assessed by APRI (1.1 vs 0.9) or FIB-4 (2.4 vs 2.6) but there was an increase in intermediate degree of fibrosis as defined by liver biopsy. The majority of Epoch 2 patients were still naive to treatment (96% Epoch 1 vs 61% Epoch 2) and a similar proportion had cirrhosis (15% Epoch 1 vs 17% Epoch 2) at the time of first visit in the different time periods. CONCLUSIONS: The patients in Epoch 2 from this urban GI referral clinic are older and the majority of them had not been treated or had not responded to treatment. This age demographic continues to reflect patients who were likely infected during the 1960’s-1980’s which is when HCV infection became widespread. Epoch 2 patients also do not have more advanced liver disease as defined either by significant fibrosis or cirrhosis as compared to Epoch 1. Possible explanations include that Epoch 2 patients’ disease was detected earlier by surveillance, progressed very slowly to advanced liver disease, or had a high mortality that resulted in a decline in patients with advanced disease. The role of access to therapy in patients not treated remains to be determined and the increased effectiveness of DAA are predicted to increase the number of AA patients seeking and accepting treatment.

FRI-227 - Lower proportion of sustained virologic response and higher residual HCV viremia at the end of direct-acting antivirals treatment in HIV/HCV co-infected as compared with HCV mono-infected patients: meaning and correlates

FRI-227 - Lower proportion of sustained virologic response and higher residual HCV viremia at the end of direct-acting antivirals treatment in HIV/HCV co-infected as compared with HCV mono-infected patients: meaning and correlates