studies

914A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
Nezam H. Afdhal - Advisory Committees or Review Panels: Trio Helath Care;
Board Membership: Journal Viral hepatitis; Consulting: Merck, EchoSens, BMS,
Achillion, GlaxoSmithKline, Springbank, Gilead, AbbVie; Grant/Research Support:
Gilead; Stock Shareholder: Springbank
Christophe Hézode - Speaking and Teaching: Roche, BMS, MSD, Janssen
K. Rajender Reddy - Advisory Committees or Review Panels: Merck, Janssen,
Vertex, Gilead, BMS, Abbvie; Grant/Research Support: Merck, BMS, Ikaria,
Gilead, Janssen, AbbVie
Steven L. Flamm - Advisory Committees or Review Panels: Gilead, Bristol Myers
Squibb, AbbVie, Janssen, Salix; Consulting: Merck, Janssen, Bristol Myers
Squibb, AbbVie, Salix, Gilead; Grant/Research Support: Janssen, Bristol Myers
Squibb, Gilead, AbbVie; Speaking and Teaching: Salix
Robert P. Myers - Employment: Gilead Sciences, Inc.; Stock Shareholder: Gilead
Sciences, Inc.
Raul E. Aguilar Schall - Employment: Gilead Sciences, Inc.
Robert H. Hyland - Employment: Gilead Sciences, Inc; Stock Shareholder: Gilead
Sciences, Inc
Phillip S. Pang - Employment: Gilead Sciences; Stock Shareholder: Gilead Sciences
Diana M. Brainard - Employment: Gilead Sciences; Stock Shareholder: Gilead
Sciences
Mani Subramanian - Employment: Gilead Sciences
John G. McHutchison - Employment: Gilead Sciences; Stock Shareholder: Gilead
Sciences
Michael R. Charlton - Grant/Research Support: GIlead Sciences, Merck, Janssen,
AbbVie, Novartis
Marc Bourlière - Advisory Committees or Review Panels: Schering-Plough,
Bohringer inghelmein, Schering-Plough, Bohringer inghelmein, Transgene; Board
Membership: Bristol-Myers Squibb, Gilead, Idenix; Consulting: Roche, Novartis,
Tibotec, Abott, glaxo smith kline, Merck, Bristol-Myers Squibb, Novartis, Tibotec,
Abott, glaxo smith kline; Speaking and Teaching: Gilead, Roche, Merck, Bristol-Myers
Squibb
1443
How gold is the “gold standard” method for staging
liver fibrosis?
Ioan Sporea; University of Medicine and Pharmacy Timisoara,
Timisoara, Romania
Backgrounds and aim: Liver biopsy (LB) is considered the gold
standard method for staging liver fibrosis. The aim of our study
was to assess the quality of liver samples obtained by percutaneous
LB in a large cohort and to determine the sensitivity of
this method for staging liver fibrosis. Material and method: We
performed a retrospective study on echo-assisted LB performed
in our Department, using 1.4 mm and 1.6 mm Menghini modified
needles, with 2 liver passages. 1012 LBs performed were
analyzed (41.4% male, 58.5% female, mean age of 46±12
years). Based on the length of the liver specimens obtained we
divided the LBs into 4 groups (< 15 mm; 15- 24 mm; 25-39
mm; > 40 mm). We calculated the length means for every
group and usingBedossa’s (1) study we analyzed the percentage
of expectedcorrectly classified biopsies according to the
length of biopsy specimen. Results: The overall mean length of
liver specimen obtained in our cohort was 33±9 mm in size,
with mean number of portal tracts of 20±10. 1%(10) of the LBS
were included in the first group (< 15 mm) with mean length of
98±2 mm. 13% (135) LBS were included in the second group
(15- 24 mm) obtaining a mean length of 20±1.8 mm.41%
(418) of the LBs had between 25 and 39 mm with a mean
length of 30±3 mm. 45% (449) of the LBs obtained specimens
larger than 40 mm with mean length of 42±5 mm.Using
Bedossa’s study (1) and diagram considering the sensitivity of
LB for staging liver fibrosis according to the length of biopsy
specimen we obtained the following sensitivities: Group 1 (<
15 mm) 55%; Group 2 (15-24 mm) 70%; Group 3 (25-39
mm) 75%; Group 4 (> 40 mm) 83% and an overall sensitivity
of 80%. Conclusions:Despite the fact that good liver specimens
are obtained using Menghini needles with 2 passages technique
the overall sensitivity of liver biopsy is only around 80%
using Bedossa criteria. References: 1. Bedossa P et al. Sampling
variability of liver fibrosis in chronic hepatitis C. Hepatology
2003;38:1449–1457.
Disclosures:
The following authors have nothing to disclose: Ioan Sporea
1444
Reproductive Aging, Independent of Chronologic Age,
Is Associated with Accelerated Fibrosis Progression in
HIV/HCV Co-Infected Women
Monika Sarkar 1 , Jennifer L. Dodge 1 , Ruth Greenblatt 1 , Mark H.
Kuniholm 2 , Jack Dehovitz 3 , Michael Plankey 9 , Andrea Kovacs 4 ,
Audrey French 7 , Eric C. Seaberg 8 , Igho Ofotokun 5 , Margaret Fischl
6 , Edgar T. Overton 10 , Erin Kelly 1 , Peter Bacchetti 1 , Marion G.
Peters 1 ; 1 University of California, San Francisco, San Francisco,
CA; 2 Albert Einstein College of Medicine, Bronx, NY; 3 SUNY
Downstate Medical Center, Brooklyn, NY; 4 University of Southern
California, Alhambra, CA; 5 Emory University, Atlanta, GA; 6 University
of Miami, Miami, FL; 7 Cook County Health and Hospitals
System, Chicago, IL; 8 Johns Hopkins University, Baltimore, MD;
9 Georgetown University Medical Center, Washington, DC; 10 University
of Alabama, Birmingham, AL
Cross sectional studies note less fibrosis in pre- versus post
menopausal women, though data lack serial fibrosis measures
and adequate adjustment for chronologic aging. Methods:
This is a retrospective cohort study of HIV/HCV co-infected
women, followed in the multicenter Women’s Interagency HIV
Study. Eligible women were pre-menopausal at entry (n=411),
confirmed by detectable anti-mullerian hormone (AMH). Subsequent
AMH loss during follow-up indicated menopausal
transition. We assessed fibrosis rate using the validated fibrosis
marker, FIB4 (level < 1.45 indicates < stage 3 fibrosis).
Fibrosis rate was evaluated in each woman as she transitioned
through menopause using random-intercept-random-slopes,
accounting for chronologic age with flexible linear splines.
Reproductive age was defined as pre- (detectable AMH), peri-
(≤ 5 yrs after AMH loss) and post-menopause (> 5 yrs after
AMH loss). Covariates included race, metabolic factors, alcohol,
and antiretroviral therapy (ART). Results: Median follow-up
was 11.5 (IQR 6-18.5) years with mean age of 44.5 (+/- 7.0)
and median entry FIB4 of 1.71 (IQR 1.2-2.6). Adjusted for
chronologic aging, fibrosis was 0.126 FIB4 per year faster
(95% CI 0.029-0.224, p=0.01) during peri-menopause and
0.149 FIB4 per year faster (95% CI 0.003-0.295, p=0.046)
during post- as compared to pre-menopause. After adjusting
for race, alcohol, and ART, accelerated fibrosis persisted in
peri- compared to pre-menopause (0.103 FIB4/year faster,
95% CI 0.007-0.200, p=0.04), though not significant (0.117,
95% CI -0.029-0.0262, p=0.12) for post- vs pre-menopausal
comparison. Conclusion: In HIV/HCV co-infected women, liver
fibrosis accelerates through peri-menopause, independent of
chronologic aging. Peri-menopausal women may have more
urgent need for HCV therapy. Longitudinal analyses of hepatic
fibrosis across reproductive age in women with non HCV-related
liver disease are warranted.