studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 489A
≥1.45 were counseled by the HIV clinic and referred to the
Division of Gastroenterology and Hepatology for liver liver
fibrosis assessment and evaluation for HCV therapy, as reimbursement
of second-generation direct-acting antivirals is
restricted to patients with ADVFIB (liver stiffness >9.5kPa/
METAVIR F3/F4) in Austria. Results: Among 1348 HIV-positive
patients, 31%(414/1348) of patients were HCV-antibody
positive and 17%(229/1348) patients had detectable serum
HCV-RNA. The majority of HIV/HCV (62%) had HCV-genotype
1 (subtype 1a:75%/1b:25%), while HCV-genotypes 2,
3, and 4 were observed in 1%, 28%, and 9% of patients.
One hundred thirteen HIV/HCV with a FIB-4 index ≥1.45
were counseled by the HIV clinic. Among these, 58%(66/113)
underwent liver fibrosis assessment either by transient elastography
(TE) or biopsy. ADVFIB was confirmed in 50% (33/66)
and IFN-free treatments were initiated in 17 of these patients
(SOF/RBV:12%[2/17]; SOF/DCV:76%[13/17]; SOF/
LDV:12%[2/17]). Importantly, among patients with a FIB-4
index ≥1.45 in whom liver fibrosis was not assessed by either
TE or biopsy (42%[47/113]), 13 patients had a FIB-4 index
>3.45, which is diagnostic for ADVFIB. None of these patients
received HCV therapy. Another 9 patients with a FIB-4 index
576,000
patients receiving AMA testing between 1/10 - 12/13 in
a large US commercial laboratory database. Patients were
considered AMA+ if antibody titre > 1:20 or M2 antibody >
25.0 U. We examined patient demographics, site of testing
& testing history. Results: 16,492 patients tested AMA+ and
had at least 1 alkaline phosphatase (ALP) test over the 4 year
period; 6,107 had an ALP >120 U/l that period and could be
classified as probable PBC. 53% of initial AMA+ tests were
conducted in a hospital setting. The specialty of the ordering
outpatient physician was gastroenterologists (18%), primary
care (14% including NP/PAs) and Rheumatologists (2%). A significant
minority of 1st AMA+ tests were male (19%). The age
at 1st AMA+ tests:
65 (40%). 55% of patients had >3 ALP tests before 1st positive
AMA; 67% had at least one ALP > 115 U/l before 1st AMA+
test, and 40% had >2 tests with ALP > 115. Conclusion: The
63% of AMA+ patients without elevated ALP (ie, probably
PBC) is similar to that reported in AASLD guidelines. Most PBC
patients’ 1st AMA+ test was in a hospital setting, suggesting
that they are being diagnosed as the result of standard screening
through other emergent conditions, not as part of regular
care. Given that early stage PBC is asymptomatic, this may
not be unexpected, except that 67% of patients had > 1 and
40% > 2 ALP test results > 115 U/l before 1st AMA+ test.
This suggests that outpatient physicians may not be following
up on elevated ALP with AMA testing. The distribution of age
is similar to prevalence studies, but the proportion of men testing
AMA+ is more than double what was expected. Other
studies suggest that men are diagnosed at a later PBC stage
than women, and have a higher mortality rate, thus a higher
proportion of incident men would ultimately produce lower
prevalence. Research on healthcare resource use shows that
in the US, men are less likely to use primary care, and instead
receive care through emergency rooms, which may explain the
high rate of hospital testing.
Disclosures:
Tracy J. Mayne - Employment: Intercept Pharmaceuticals
Herbert Swanson - Management Position: Intercept
David Shapiro - Employment: Inttercept Pharmaceuticals; Management Position:
Intercept Pharmaceuticals; Stock Shareholder: Intercept Pharmaceuticals
W. Ray Kim - Advisory Committees or Review Panels: Bristol Myers Squibb,
Gilead Sciences, Abbvie, Merck
The following authors have nothing to disclose: Keith D. Lindor
563
Worse Outcomes Among Uninsured Patients with Cirrhosis
– Towards Understanding the Obstacles to Hepatology
Care
Daniela Ladner 1 , Kathryn Skibba 1 , Kathryn Jackson 1 , Niloufar
Safaeinili 1 , David S. Goldberg 2 , Lisa B. VanWagner 1 , Satyender
Goel 1 , Abel Kho 1 , Amna Daud 1 , Nazanin Salehitezangi 1 , Anton
I. Skaro 1 ; 1 Northwestern University, Chicago, IL; 2 University of
Pennsylvania, Philadelphia, PA
Background: Cirrhosis of the liver is a leading cause of morbidity
and mortality in the US and worldwide. Advanced hepatology
care and transplantation can improve survival and quality
of life. However, discrete obstacles to access to appropriate
liver-specific care exist. Due to an absence of epidemiologic
data collected systematically on the cirrhotic patient population
the nature and magnitude of the problem remains poorly characterized.
Longitudinal measurement of MELD is an adequate
surrogate of access to care. Therefore, we examined outcomes