studies

252A AASLD ABSTRACTS HEPATOLOGY, October, 2015
HCV RNA levels of 150-250 IU/mL. Testing undenatured, but
not denatured serum samples reliably differentiated active from
past HCV infection and accomplished screening and diagnosis
of HCV infection in one step.
Disclosures:
The following authors have nothing to disclose: Ke-Qin Hu, Wei Cui
86
Hepatitis C Virus (HCV) Mortality Patterns in the British
Columbia Hepatitis Testers Cohort (BC-HTC)
Mel Krajden 1,2 , Amanda Yu 1 , Darrel Cook 1 , Margot E. Kuo 1 ,
Maria Alvarez 1 , Mark Tyndall 3,2 , Naveed Z. Janjua 1,2 ; 1 Clinical
Prevention Services, BC Centre for Disease Control, Vancouver,
BC, Canada; 2 University of British Columbia, Vancouver, BC, Canada;
3 BC Centre for Disease Control, Vancouver, BC, Canada
Objective: To describe the population-level impacts of HCV
acquisition risks vs. chronic infection on mortality for HCV
negative and positive testers. Methods: The British Columbia
Hepatitis Testers Cohort (BC-HTC) includes 1,135,947 individuals
tested for HCV or reported to public health as a HCV
case from 1990-2013, linked to their corresponding healthcare
administrative data. Cohort entry was delayed one year
for each individual and deaths within one year of HCV diagnosis
were excluded, i.e., one year lagging. We computed
age-adjusted annual all-cause, liver- and drug-related mortality
rates/100,000 population and age-, sex- and year-adjusted
standardized mortality ratios (SMRs) for: 1) seroconverters,
those with known HCV acquisition timeframes and risk activities;
2) anti-HCV positive on initial testing, the majority of whom
were chronically infected and most of whom no longer engage
in acquisition risk activities; and 3) HCV negatives. Results:
Of 1,028,227 individuals included in this analysis, 64,876
(6.3%) were HCV positive. Overall, 16.3% (10,572/64,876)
of HCV positive vs. 6.4% (61,623/963,351) of HCV negative
individuals died. For HCV positives, age-adjusted allcause
mortality increased from 0.11/100,000 in 1993 to
15.0 in 2005 and stayed in this range thereafter. Liver-related
mortality increased from 0.03/100,000 in 1993 to 2.5 in
2005 to 4.7 in 2013. Drug-related mortality increased from
0.03/100,000 in 1993, peaked at 3.2 in 2005 and declined
to 1.3 by 2013. All-cause, liver- and drug-related mortality
rates were consistently higher for males vs. females. All-cause
mortality for seroconverters was significantly higher than those
with chronic HCV and HCV negatives (SMRs: 4.8, 3.1 and
1.0). Liver-related mortality was significantly lower for seroconverters
than for chronic HCV and was lowest for HCV negatives
(SMRs: 10.4, 17.0 and 1.4). Similarly, liver cancer mortality
was significantly lower for seroconverters than for chronic HCV
and was lowest for HCV negatives (SMRs: 3.8, 17.5 and 1.3).
However, drug-related mortality was highest for seroconverters
compared to chronic HCV and HCV negatives (SMRs: 17.0,
11.4 and 0.9). Conclusions: The BC-HTC enables comprehensive
assessment of the mortality impacts of HCV infection and
creates an opportunity to differentiate acquisition risk mortality
from the impacts of chronic infection. These data illustrate that
the excess mortality related to HCV acquisition risks is distinct
from viral sequelae for a significant proportion of the HCV
infected population. Therefore antiviral treatment on its own
will not optimize mortality reductions in the affected populations.
Disclosures:
Mel Krajden - Grant/Research Support: Roche, Merck, Siemens, Boerhinger
Ingelheim, Hologic
The following authors have nothing to disclose: Amanda Yu, Darrel Cook, Margot
E. Kuo, Maria Alvarez, Mark Tyndall, Naveed Z. Janjua
87
The Association of Sustained Virological Response and
All-cause Mortality After Interferon-based Therapy for
Chronic Hepatitis C (HCV) in a Large U.S. Community-based
Health Care Delivery System
Lisa M. Nyberg 1 , Xia Li 1 , Su-Jau Yang 1 , Kevin Chiang 1 , T. Craig
Cheetham 1 , Susan Caparosa 1 , Jose R. Pio 1 , Zobair M. Younossi 2 ,
Anders H. Nyberg 1 ; 1 Kaiser Permanente, San Diego, CA; 2 Department
of Medicine, Inova Fairfax Medical Campus, Fairfax, VA
Background: Previous studies performed at tertiary care centers
have shown that sustained virological response (SVR) to interferon-based
therapy for HCV is associated with a reduction
of liver-related and all-cause mortality (1-2). The aim of this
study was to determine if SVR to interferon-based therapy in
a community-based health care setting is associated with a
reduction in all-cause mortality and to examine for differences
in those with and without cirrhosis. Methods: A retrospective
cohort study at Kaiser Permanente, Southern California (KPSC),
a large community-based integrated health care system including
3.5 million members. Inclusion criteria: a diagnosis code
and/or positive lab test for HCV RNA (index date) 1/1/02-
12/31/13; age ≥ 18 years at index date, ≥ 12 months continuous
membership before and after index date. Exclusion
criteria: HCV diagnosis after 1/1/13 and liver transplant or
HCC on or before index date. SVR was determined for patients
treated for HCV with interferon-based therapy and stratified for
cirrhosis vs non-cirrhosis. Mortality data were obtained from the
California Department of Public Health Vital Statistics of California
Report. Results: Total study cohort: 24,968 with chronic
HCV; of those 10,449 (42%) had cirrhosis. Overall mortality
during the study period was 18.5% (4,608/24,968). Mortality
among those with cirrhosis was 33.2% (3,470/10,449) vs
7.8% (1,138/14,519) among those without cirrhosis. Among
patients treated for HCV, 45.1% (2348/5203) achieved SVR;
mortality for those who achieved SVR was 5.4% (127/2348)
vs 18.9% (540/2855) for those without SVR. Mortality in
treated patients, with and without cirrhosis, is shown in Table
1. Conclusions: An approximate 3-fold reduction in all-cause
mortality is seen in patients with HCV who are treated and
achieve SVR compared to those without SVR. Cirrhotics who
are treated and achieve SVR have a > 3-fold reduction in mortality
compared to the mortality in treated cirrhotics who do not
achieve SVR. New, more potent, HCV treatment regimens with
higher SVR have the potential of significantly reducing future
mortality due to HCV. Further study is ongoing with matching
for severity of liver disease to more specifically examine the
effect of SVR on mortality compared to that due to the natural
history of HCV/cirrhosis. 1. van der Meer, et al. JAMA 2012
Dec26;308(24):2584-93. 2. Berenguer, et al. Hepatology
2009 Aug;50(2):407-13
Mortality in HCV patients treated with interferon-based therapy.
Cirrhosis: N=2603; No Cirrhosis: N=2600
Disclosures:
Lisa M. Nyberg - Grant/Research Support: Merck, Gilead, Abbvie
T. Craig Cheetham - Grant/Research Support: Gilead, BMS
Zobair M. Younossi - Advisory Committees or Review Panels: Salix, Janssen,
Vertex; Consulting: Gilead, Enterome, Coneatus
The following authors have nothing to disclose: Xia Li, Su-Jau Yang, Kevin Chiang,
Susan Caparosa, Jose R. Pio, Anders H. Nyberg