studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1001A
1624
Assessment Of Treatment Response By Elastography
During The Tenofovir Treatment In Nucleos(t)ide-Naïve
Chronic Hepatitis B Patients
Taeheon Lee, Byung Ik Kim, Yong Kyun Cho, Woo Kyu Jeon, Hong
Joo Kim; Kangbuk Samsung Hospital, Seoul, Korea (the Republic
of)
Aim: Several longitudinal studies have demonstrated that elastrograpy
could be a useful tool for monitoring of liver fibrosis
during the treatment of chronic hepatitis B. However, not
enough studies assessing regression of liver fibrosis by elastography
are available to date. Therefore, the purpose of this study
was to evaluate the liver stiffness before and during the treatment
and assess the usefulness of this non-invasive modality.
Methods: Fourty-eight treatment-naïve patients started treatment
with tenofovir. Liver stiffness measurement by a shear wave
elastography and a conventional ultrasonography was performed
at baseline, after median 6 and 12 months. Cut-off levels
to Metavir classification for fibrosis stage F0-1, F2, F3 and
F4 were ≤5.6 kPa, ≤7.44 kPa, ≤8.71 kPa, and ≥10.87 kPa,
respectively. Result: Median liver stiffness decreased from 6.68
kPa(SD, ±3.90), 6.27(SD, ±3.88) and 5.69 kPa(SD, ±5.01) in
patients treated with tenofovir at baseline, after median 6 and
12 months. There were no significant difference in the degree
of regression of liver stiffness after median 6 (P =0.29) and 12
months (P =0.14). Twenty-two(45.9%) subjects were classified
as F0-1, 3 (6.3%) as F2, 20 (41.7%) as F3, and 3 (6.3%) as
F4. After median 6 and 12 months later, liver stiffness value of
patients recorded as F0-1 was decreased mean 0.60 kPa(SD,
±2.38) and 0.05 kPa(SD, ±2.17), F2 as 0.81 kPa(SD, ±1.69)
and 0.99 kPa(SD, ±3.01), F3 as 0.81 kPa(SD, ±3.75) and
1.02 kPa(SD, ±5.67)a and F4 as 13.23 kPa(SD, ±7.59) and
4.50 kPa (P for trend =0.01 and 0.04 after 6months and
12 months) Conclusion: Liver stiffness was not significantly
improved during the tenofovir treatment in patients with chronic
hepatitis B during 6 and 12 months. But these result showed a
trend that in a patient with advanced fibrosis on baseline stiffness
stage was more improvedcompared to that of mild fibrosis
during 6 and 12 months. Long term prospective studies are
required to investigate the usefulness of elastography for relationship
between elastography stiffness and treatment response
in chronic hepatitis B patients treated with tenofovir.
Disclosures:
The following authors have nothing to disclose: Taeheon Lee, Byung Ik Kim, Yong
Kyun Cho, Woo Kyu Jeon, Hong Joo Kim
1625
Inadequate Treatment of Chronic Hepatitis B in Pregnant
Women at High Risk for Vertical Transmission
Diana Y. Wu 1,2 , muhammad I. Shafi 3,2 , Mohammed M. Aboelsoud
3,2 , Colin Woodard 4,2 ; 1 Gastroenterology, Women and
Infants Hospital, Providence, RI; 2 Brown University, Alpert Medical
School, Providence, RI; 3 Internal Medicine, Memorial Hospital,
Pawtucket, RI; 4 Internal Medicine, Kent Hospital, Warwick, RI
Aim: To describe the clinical presentation and management of
a cohort of pregnant women with hepatitis B in a single center
specializing in obstetrics care. Methods: Pregnant women
with positive hepatitis B surface antigen who were seen at
Women and Infants Hospital, Providence, Rhode Island from
2009-2014 were included. Medical records were reviewed for
demographic and clinical information from initial presentation
for positive hepatitis B surface antigen until time of delivery.
Results: 112 women were included, median age 28 yrs. Of the
76 women who had their birth countries recorded in their medical
record, only seven (9%) were born in the United States.
Median follow up was 4.8 months. 19 (17%) women had ALT
levels more than twice the upper limit of normal for women (19
U/L) during their pregnancy. 20 (18%) women were hepatitis
B e-antigen positive. 15 women (13%) had HBV DNA levels
> 200,000 IU/ml in the third trimester of pregnancy, which
qualified them for initiation of treatment for chronic hepatitis B
to prevent vertical transmission to their fetus. Five of these pregnant
women were initiated on Lamivudine, three on Tenofovir,
and one on Adefovir in their third trimesters. However, five of
the eligible 15 (33%) women were not initiated on treatment
during pregnancy to prevent vertical transmission, and a sixth
woman declined therapy. Two of the 112 women in the study
were already on therapy for chronic hepatitis B before pregnancy,
one on Lamivudine and one on Adefovir, which were
continued throughout pregnancy. One woman was on Entecavir
before pregnancy and was not switched to a different oral
agent during pregnancy. Another woman on Entecavir before
pregnancy was switched to Telbivudine during pregnancy.
Conclusions: Although there is universal screening of pregnant
women in prenatal care in the US for chronic hepatitis B, there
remains inadequate initiation of treatment in the third trimester
for patients with high viral load, who are at high risk of vertical
transmission. Furthermore, this study shows that there should
be improved knowledge of safe oral antiviral therapies for
hepatitis B in pregnancy.
Disclosures:
The following authors have nothing to disclose: Diana Y. Wu, muhammad I.
Shafi, Mohammed M. Aboelsoud, Colin Woodard
1626
NK cell function is restored with sequential NUC therapy
and correlates with treatment response in Chronic Hepatitis
B
Upkar S. Gill 1 , Dimitra Peppa 2 , Lorenzo Micco 2 , Harsimran D.
Singh 2 , Ivana Carey 3 , Graham R. Foster 1 , Mala K. Maini 2 , Patrick
T. Kennedy 1 ; 1 Hepatology Unit, Centre for Immunobiology,
Blizard Institute, Barts and The London, School of Medicine & Dentistry,
QMUL, London, United Kingdom; 2 Division of Infection &
Immunity, UCL, London, United Kingdom; 3 Institute of Liver Studies,
Kings College London, London, United Kingdom
INTRODUCTION: New treatment strategies to achieve HBsAg
loss in Chronic Hepatitis B (CHB) are required. Sequential/
combined therapeutic approaches comprising Pegylated-Interferon
(Peg-IFNα) and nucleot(s)ide analogues (NUC) are being
given greater consideration. We previously demonstrated
boosting of NK cells in eAg- patients treated with Peg-IFNα
(Micco et al, J. Hepatol, 2013). Here we studied differential
NK cell responses in patients receiving sequential NUC therapy,
after Peg-IFNα exposure, to elucidate a possible treatment
advantage over current therapy strategies. PATIENTS &
METHODS: PBMC from 43 eAg+ patients were analysed. 21
patients underwent a 48-week course of Peg-IFNα and were
studied longitudinally; 12/21 progressed to sequential NUC
therapy and were followed until viral suppression. 12 patients
receiving de novo NUC therapy, without Peg-IFNα exposure
were compared for analysis. In addition 10 patients exposed
to Peg-IFNα, and not progressing to sequential NUC therapy,
were also studied for comparison. Phenotypic and functional
analysis of NK cell subsets was performed by multicolour
flow-cytometry and findings correlated with on-therapy HBsAg
changes. RESULTS: There was cumulative expansion of activated
and functional CD56 bright NK cells throughout 48-weeks
of Peg-IFNα (p=0.0001), maintained at higher than pre-treatment
levels for at least 9-months after switching to sequential