studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 253A
88
Increasing Prevalence of Cirrhosis among US Adults
with Chronic Hepatitis C Virus Infection: Results from
NHANES 1988-1994 and 1999-2012
Prowpanga Udompap, Ajitha Mannalithara, Nae-Yun Heo, Donghee
Kim, W. Ray Kim; Division of Gastroenterology and Hepatology,
Stanford University School of Medicine, Stanford, CA
Background & Aims: Hepatitis C virus(HCV) is a major cause
of end stage liver disease and hepatocellular carcinoma worldwide.
While cirrhosis underlies these complications, the prevalence
of HCV cirrhosis in the US remains unknown. We aim
to determine the prevalence of advanced fibrosis/cirrhosis and
to identify factors associated with advanced fibrosis/cirrhosis
in people with chronic hepatitis C in the US population. Methods:
Using the National Health and Nutrition Examination Survey(NHANES)
data, we identified participants with detectable
serum HCV RNA and assessed liver fibrosis using validated
surrogate indicators, including APRI and FIB-4 scores. The prevalence
of cirrhosis was determined for survey participants for
Era 1 (1988-94), Era 2 (1999-2006) and Era 3 (2007-12).
Results: Out of 52,644 participants with age ≥20, 736 (1.4%)
had HCV. Based on APRI score, 6.6% (95%CI:2.2-11.0) of
US adults with HCV infection in Era 1, 7.6% (95%CI:3.4-
11.8) in Era 2 and 17.0% (95%CI:8.0-26.0) in Era 3 were
estimated to have cirrhosis (Ishak stage 5-6). The prevalence
of advanced fibrosis (Ishak stage 4-6) based on FIB-4 was
8.6%, 10.1%, and 16.0% for Eras 1, 2, and 3, respectively.
These data project to 370,500 Americans with cirrhosis and
347,800 with advanced fibrosis in the most recent era. The
higher prevalence of cirrhosis (determined by APRI) in the
recent era was associated with increasing age (OR=1.04,
95%CI:1.02-1.07), diabetes (OR=2.33, 95%CI:1.01-5.40)
and obesity (OR=2.96, 95%CI:1.15-7.57). When FIB-4 score
was used, advanced fibrosis was associated with increasing
age (OR=1.08, 95%CI:1.05-1.11) and diabetes (OR=3.37,
95%CI:1.24-9.5). Conclusion: Nearly one in five US adults
with HCV infection have cirrhosis. The prevalence of cirrhosis
is rising over time, which is in part attributable to the increasing
age of the birth cohort with HCV infection. In addition, comorbidities
such as diabetes and obesity accelerate liver fibrosis.
These data further underscore the current recommendations
for HCV screening in asymptomatic individuals and highlights
the need for systematic assessment for liver fibrosis and comprehensive
medical management in those with HCV infection.
Characteristics of participants
89
Rectal Shedding of HCV in HCV/HIV Co-infected Men
Andrew L. Foster 1,2 , Michael Gaisa 1 , Rosanne M. Hijdra 1,3 , Karen
B. Jacobson 1 , Samuel Turner 1,2 , Tristan Morey 1,2 , Daniel S. Fierer 1 ;
1 Infectious Diseases, Mount Sinai School of Medicine, New York,
NY; 2 James Cook University, Cairns, QLD, Australia; 3 Amsterdam
Medical Center, Amsterdam, Netherlands
Introduction An epidemic of hepatitis C virus (HCV) infection
is occurring among HIV-infected men who have sex with men
(MSM). Epidemiological studies suggest that sexual transmission
is fueling the epidemic. Blood and semen have been considered
as potential mechanisms of transmission, but there are
still transmission circumstances that remain unexplained. We
hypothesized that HCV may be shed into rectal fluid of HCV/
HIV co-infected MSM. Methods Written informed consent was
obtained from 45 HIV-infected MSM with HCV infection and
paired blood and rectal fluid specimens were obtained. Rectal
fluid was collected using a moistened polyester-tipped swab
that was gently inserted into the rectum. The swab was placed
into transport medium, vortexed, and the supernatant analysed
for HCV using COBAS AMPLICOR (Roche Diagnostics), lower
limit of quantification 43 IU/mL, lower limit of detection 7 IU/
mL. The experimentally-determined efficiency of HCV absorption
to and elution from the swabs was used to calculate the
rectal HCV viral load (VL). Rectal sexually-transmitted infection
(STI) and blood syphilis testing were also performed. Results
Visual inspection of the swabs showed no visible blood on
any. HCV was detected in 20 (47%) of 43 specimens. Among
those samples with HCV detected, the median rectal VL was
2.92 log 10
IU/mL (IQR 2.92, 4.27). Rectal HCV detection was
associated with serum HCV VL >5 log 10
IU/mL (p=0.011),
and there was a high correlation between the magnitude of
blood VL and rectal HCV VL (correlation coefficient 0.688,
p