studies

1080A AASLD ABSTRACTS HEPATOLOGY, October, 2015
The following authors have nothing to disclose: Anders H. Nyberg, Ekaterina
Sadikova, Jiaxiao Shi, Kevin Chiang
1789
Cause of death in HCV patients who achieved sustained
virologic response: Chronic Hepatitis Cohort Study
(CHeCS), 2006-2012
Fujie Xu 1 , Jian Xing 1 , Anne C. Moorman 1 , Loralee B. Rupp 2 , Stuart
C. Gordon 2 , Mei Lu 2 , Eyasu H. Teshale 1 , Philip R. Spradling 1 ,
Joseph A. Boscarino 3 , Connie M. Trinacty 4 , Mark A. Schmidt 5 ,
Scott D. Holmberg 1 ; 1 Division of Viral Hepatitis, CDC, Atlanta,
GA; 2 Henry Ford Health System, Detroit, MI; 3 Geisinger Health
System, Danville, PA; 4 Kaiser Permanente Hawaii, Honolulu, HI;
5 Kaiser Permanente Northwest, Portland, OR
Background: Successful treatment of chronic HCV infection is
associated with reduced morbidity and mortality. The objective
of this study was to describe the stage of liver disease at the
time of sustained virologic response (SVR) and the timing and
cause of death in post-SVR patients. Methods: We analyzed
data from the Chronic Hepatitis Cohort Study (CHeCS), an
ongoing ‘dynamic’ observational study of patients with chronic
HCV conducted at four integrated health care systems located
in the United States (Henry Ford Health System, Geisinger
Clinic, Kaiser Permanente-Northwest, and Kaiser Permanente-Hawaii).
The stage of liver disease was approximated by
FIB-4 score within 3 months of the SVR date (at 12 weeks post
treatment). Deaths that occurred in 2006-2012 were ascertained
by matching cohort patient records to the most recent
National Death Index, Social Security Death Index, or electronic
state death registries. We examined the causes of death
listed on death certificates in patients whose HCV treatment
had resulted in SVR. Results: Of 15,158 HCV patients enrolled
in CHeCS, HCV treatment resulted in SVR in 1,492 (9.8%)
patients between 2000 and 2012. Of these 1,492 patients,
785 (52.6%) had one or more FIB-4 scores measured within
3 months of the SVR date: the median FIB-4 score was 1.75,
and 24.8% had a FIB-4 score >3.25. During 2006-2012,
2,314 (15.3%) deaths occurred in HCV cohort patients, and
of these, 71 (3.1%) were in patients known to have achieved
SVR (4.8% (71/1,492) of SVR patients died versus 16.4%
(2243/13,666) of non-SVR patients, p3.25 prior to SVR; the mean time
from SVR date to death was 4.9 years (95% CI, 3.5-6.2),
ranging from 1.4 years to 9.3 years. Conclusion: In a large
HCV cohort in the United States, only 10% had achieved SVR
by the end of 2012. While mortality among patients who had
achieved SVR was lower, premature death and liver cancer
can still occur and may be related to the late stage of liver
disease at the time of treatment and SVR.
Disclosures:
Stuart C. Gordon - Advisory Committees or Review Panels: Janssen; Consulting:
Merck, Gilead, BMS, CVS Caremark, Amgen, AbbVie; Grant/Research Support:
Merck, Gilead, AbbVie, Intercept Pharmaceuticals, Exalenz Sciences, Inc., BMS
The following authors have nothing to disclose: Fujie Xu, Jian Xing, Anne C.
Moorman, Loralee B. Rupp, Mei Lu, Eyasu H. Teshale, Philip R. Spradling, Joseph
A. Boscarino, Connie M. Trinacty, Mark A. Schmidt, Scott D. Holmberg
1790
Development of End Stage Liver Disease, Hepatocellular
Carcinoma and Liver-Related Death According to
Biopsy-Confirmed Ishak Fibrosis Stage in the Hepatitis C
Alaska Cohort Study (AK-HepC)
Dana J. Bruden 1 , Lisa J. Townshend-Bulson 2 , James E. Gove 2 , Julia
N. Plotnik 2 , Chriss E. Homan 2 , Annette Hewitt 2 , Michael Bruce 1 ,
Prabhu P. Gounder 1 , Youssef Barbour 2 , Brenna Simons-Petrusa 2 ,
Brian J. McMahon 2,1 ; 1 Arctic Investigations Program, Division of
Preparedness and Emerging Infections, Centers for Disease Control
and Prevention, Anchorage, AK; 2 Liver Disease and Hepatitis
Program, Alaska Native Tribal Health Consortium, Anchorage, AK
Background Most studies on liver biopsy results among hepatitis
C virus (HCV) infected persons are of a cross-sectional study
design. Long-term prospective studies of the outcomes associated
with HCV are rare and critical for assessing the potential
impact of HCV treatment on sequelae. We used liver biopsy
as a study start point and looked at development of end stage
liver disease (ESLD), hepatocellular carcinoma (HCC) and liver-related
death (LRD) according to the Ishak fibrosis score.
Methods Since 1994, all American Indian/Alaska Native (AI/
AN) persons positive for anti-HCV have been invited to enroll in
a long-term study of HCV outcomes. By 2012, 1,325 persons
were enrolled, of whom 1,080 were HCV RNA-positive, and
of these, 412 had a liver biopsy performed. In persons with
multiple liver biopsies, the most recent was used. The Ishak
fibrosis score was used to categorize persons into mild/moderate
(Ishak = 0, 1, 2), severe (Ishak = 3, 4) or cirrhosis (Ishak
= 5, 6). The date of liver biopsy was the starting point in a
survival analysis examining time until development of ESLD,
HCC and LRD. We report survival probabilities at 5-years using
Kaplan-Meier estimates. Results Of 412 persons undergoing
liver biopsy, 68% (n = 282) had mild/moderate fibrosis, 21%
(n = 87) had severe fibrosis and 10% (n = 43) had cirrhosis.
The average length of following liver biopsy was 7.7 years
with a total of 3,162 years of follow-up. The average age
at the time of biopsy was 44.3 years and 51% (n = 211)
were female. Within 5 years of biopsy, 4.6% (95% confidence
interval (CI): 2.5, 8.5) of persons with mild/moderate fibrosis
had developed ESLD compared to 16.4% (CI: 9.6, 27.2) and
45.1% (CI: 29.7, 63.9) of persons with severe fibrosis and
cirrhosis, respectively (p