studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1063A
Tacrolimus/steroid boli. Conclusions: A b-ppT SOF/R-regimen
in HCV-listed cirrhotics with suboptimal virological response at
the time of transplant, might represent an optimal strategy to
avoid post-transplant graft reinfection.
Disclosures:
Sherrie Bhoori - Speaking and Teaching: Bayer, BTG
Vincenzo Mazzaferro - Advisory Committees or Review Panels: Bayer; Grant/
Research Support: BTG
Paolo Caraceni - Advisory Committees or Review Panels: GSK; Consulting: BMS;
Grant/Research Support: Grifols; Speaking and Teaching: Baxter, Kedrion
The following authors have nothing to disclose: Maria F. Donato, Sonia Berardi,
Rosa Maria Iemmolo, Luca S. Belli, Marzia Montalbano, Giulia Pieri, Ilaria Lenci,
Alessandra Riva, Veronica Bernabucci, Sara Monico, Chiara Mazzarelli, Federica
Malinverno, Daniele E. Dondossola, Chiara Taibi, Giorgio Rossi, Antonio
Daniele Pinna, Fabrizio Di Benedetto, Luciano De Carlis, Giuseppe M. Ettorre,
Umberto Montin, Giuseppe Tisone, Marco Vivarelli, Maria Rosa Tamè, Maria
Cristina Morelli
1752
Hepatitis E infection in immunocompromised persons in
Argentina
Jose Debes 1 , Maribel Martinez Wassaf 2 , Maia Belen Pisano 3 , Leonardo
Marianelli 4 , Martin Lotto 3 , Domingo Balderramo 5 , Hernan
Coseano 5 , Viviana Re 3 ; 1 University of MInnesota, Minneapolis,
MN; 2 Área de Virología y Biología Molecular, LACE Laboratorios,
Cordoba, Argentina; 3 Instituto de Virología “Dr.J.M.Vanella”, Facultad
de Ciencias Médicas, Universidad Nacional de Córdoba,
Cordoba, Argentina; 4 Hospital Rawson, Cordoba, Argentina;
5 Hospital Privado, Cordoba, Argentina
Background: Hepatitis E virus (HEV) is a single-stranded RNA
virus that can cause hepatitis in an epidemic fashion. In immunocompetent
individuals, infection with HEV usually leads to
silent seroconversion or to acute self-limited disease. Several
reports suggest an increased rate of seroprevalence of HEV in
immunosuppressed individuals, particularly those undergoing
solid-organ transplantation. In this setting, HEV can develop
into a chronic infection. The data is less clear in patients
infected with human immunodeficiency virus (HIV). Moreover,
information about prevalence of HEV in immunocopromised
subjects outside of Europe or North America is scarce. In this
study we addressed the seroprevalence of HEV in immunocompromised
subjects in Argentina and associated risk factors.
Methods: We performed third generation enzyme immunoassay
for determination of IgG specific antibodies against HEV
in 95 subjects infected with HIV, 81 subjects on hemodialysis
(HD) and 58 solid-organ transplant recipients. On those samples
that were positive for HEV IgG, further assessment of HEV
IgM levels. HEV PCR was performed in all samples. Subjects on
HD and transplant recipients were evaluated regarding social
habits and potential risk factors. Results were compared to
433 HIV-negative, immunocompetent controls from our center.
Results: In our entire HIV-positive group we found 8 of
95 samples to be positive for HEV IgG (8.8%), compared to
19 of 433 samples (4.4%) in the control group. Interestingly,
in a subgroup of patients (N27) with low CD4 counts 18%
were positive for HEV IgG (p=0.03, compared to controls).
This group had a much lower CD4 count when compared to
the general HIV cohort (median CD4 count of 43/mm3 vs
543/mm3 respectively). Eight out of 81 subjects (9.8%) on HD
and 5 of 58 (8.6%) of transplant recipients were positive for
HEV IgG. Interestingly, half of HEV seropositive patients in the
HD group had positive IgM for HEV. There was no association
between HEV serostatus and consumption of pork, fish, potable
water or history of blood transfusion. Only 1 sample showed
a positive PCR for HEV, within the HIV group. This patient
had recent history of vomiting and diarrhea and likely experienced
acute HEV infection. Conclusions: Our study found an
increased seroprevalence of HEV IgG in subjects infected with
HIV, on HD and solid-organ transplant recipients in Argentina.
However, the only significant difference compared to controls
was on HIV-infected patients with low CD4 counts.
Disclosures:
The following authors have nothing to disclose: Jose Debes, Maribel Martinez
Wassaf, Maia Belen Pisano, Leonardo Marianelli, Martin Lotto, Domingo Balderramo,
Hernan Coseano, Viviana Re
1753
Oral Interferon-free Antiviral Regimens in Liver Transplant
Recipients with Hepatitis C: a Real Life Experience
Arun Mannem 2,1 , Shari S. Rogal 2 , Vivek Sharma 2 , Fadi Francis 2 ,
Thomas V. Cacciarelli 2 , Obaid S. Shaikh 2,1 ; 1 Medicine/Gastroenterology,
University of Pittsburgh School of Medicine, Pittsburgh,
PA; 2 Medicine/Gastroenterology, Veterans Affairs Pittsburgh
Healthcare System, Pittsburgh, PA
Purpose: Oral interferon-free regimens are highly effective for
hepatitis C (HCV) in the immunocompetent population. However,
their role in transplant recipients is not well established.
This study aimed to determine the real life experience with
such regimens in liver transplant recipients. Methods: Beginning
in 2013, all patients evaluated for HCV at VA Pittsburgh
Healthcare System were prospectively entered in a quality
of care database. One hundred twenty five liver transplant
recipients with HCV were identified; 25 were excluded [treatment
with interferon based regimens (13), transplant at a
different center (6), lack of complete data (4), primary graft
failure (2), and treatment in a clinical trial (1)]. Data regarding
demographics, prior post-transplant treatment, HCC and
MELD status and treatment were collected. Results: Among 100
patients studied, 96 received transplant during 2001-2014.
Most patients were adult, white males and received tacrolimus
based immunosuppression. Eighty-six (86%) had genotype 1,
1 (1%) genotype 2, 12 (12%) genotype 3 and 1 (1%) genotype
4. Among genotype 1 patients, 60/86 (70%) underwent
treatment post-transplant; 26/60 (43%) received combination
sofosbuvir/simeprevir (SOF/SIM), 5 (8%) ledipasvir/sofosbuvir
(LED/SOF) x 12 weeks, 6 (10%) LED/SOF x 24 weeks,
21 (35%) LED/SOF/ribavirin (RBV) x 12 weeks and 1 (2%)
received LED/SOF/RBV x 24 weeks. Rapid virologic response
rates at 4 weeks of treatment (RVR) follow: - SOF/SIM 16/26
(62%), LED/SOF-12 weeks 2/5 (40%), LED/SOF-24 weeks
3/6 (50%), LED/SOF/RBV-12 weeks 14/21 (67%) and LED/
SOF/RBV-24 weeks 0/1 (0%). The single genotype 2 patient
was treated with SOF/RBV and response is awaited. Four genotype
3 patients were treated- 1 (25%) received SOF/SIM,
2 (50%) LED/SOF x 12 weeks and, 1 (25%) SOF/RBV. The
single genotype 4 patient had treatment with LED/SOF/RBV x
12 weeks and achieved RVR. The full treatment outcomes are
awaited and will be reported at the meeting. Conclusion: Our
study will shed light on real world treatment outcomes with the
all oral interferon-free regimens in liver transplant recipients
with HCV. It will help establish the tolerability, efficacy and
duration of therapy in this special population.
Disclosures:
Shari S. Rogal - Grant/Research Support: Gilead Sciences