studies

1094A AASLD ABSTRACTS HEPATOLOGY, October, 2015
follow-up time) patients. Post treatment MELD score changes
showed considerable heterogeneity with SVR patients showing
an average MELD decrease of 2.0 (95% confidence interval
0.9 - 3.1, p=0.0003) MELD points compared to patients who
failed SVR. Even within the SVR group, 33% of the patients
had post treatment increases in MELD score while 63% had a
decrease. Four patients had refractory ascites requiring paracentesis
prior to treatment and none required paracentesis after
SVR. One patient developed refractory ascites after treatment.
Four patients had hepatic encephalopathy (PSE) related hospital
admission prior to treatment but only 1 had further PSE
related admissions after treatment. Three new patients developed
PSE related admission for the first time after treatment,
and one patient developed HCC after SVR. In summary, 3/4 of
decompensated HCV cirrhotics were able to achieve SVR with
approximately 2/3 of the SVR patients achieving decreased
MELD score. Most patients with refractory symptoms had clinical
benefits such as reduced paracentesis and encephalopathy
related admissions. Improvement is not universal and patients
should be carefully monitored. DAA treatment for advanced
cirrhosis is not a substitution for transplant. For those patients
who did not achieve SVR, deterioration occurred in half. HCV
treatment is thus indicated, even in the most advanced cases
and a significant proportion of these patients may improve to
the point of not requiring liver transplantation.
Disclosures:
Prashant K. Pandya - Grant/Research Support: Gilead, Merck; Speaking and
Teaching: Genentech, AbbVie, Vertex
Jody C. Olson - Advisory Committees or Review Panels: Baxter
Richard Gilroy - Speaking and Teaching: Salix, NPS, Gilead, AbbVie, Novartis
Steven A. Weinman - Consulting: Cardax, Inc.
The following authors have nothing to disclose: Winston Dunn, Melissa Whitener,
Shweta Chakraborty, Anusha Vittal, K. James Kallail, Brian Bridges, Chuanghong
Wu, Ryan Taylor, Timothy Schmitt, Mojtaba S. Olyaee
1816
Low HCV Treatment for Chronic Hepatitis C (CHC)
Patients in Pre-Protease Inhibitor (PI) and Post-PI/Pre-Direct
Acting Antiviral (DAA) Eras Compared to Post-DAA
Era, Especially in African Americans: Analysis of A
Large Real-World Cohort of 7105 Patients
Peter T. Nguyen 2,1 , Nghia H. Nguyen 3,1 , Joseph K. Hoang 1 ,
Changqing Zhao 1,4 , An K. Le 1 , Christine Y. Chang 1 , Richard H.
Le 1 , Michael D. Nguyen 1 , Mingjuan Jin 5,1 , Susan C. Weber 6 , Lee
Ann Yasukawa 6 , Mindie H. Nguyen 1 ; 1 Division of Gastroenterology
and Hepatology, Stanford University Medical Center, Palo
Alto, CA; 2 University of Texas Medical Branch, Galveston, TX;
3 Department of Medicine, University of California, San Diego, San
Diego, CA; 4 Department of Cirrhosis, Institute of Liver Disease,
Shuguang Hospital, Shanghai, China; 5 Department of Epidemiology
and Biostatistics, School of Public Health, Zhejiang University,
Hangzhou, China; 6 Center for Clinical Informatics, Stanford University
School of Medicine, Palo Alto, CA
Background & Aim: Utilization of PEG IFN+RBV (P/R) is generally
low for CHC due to adverse events (AE) and low SVR.
More efficacious triple P/R+PI therapy was approved in 2011
but treatment rate may also remain low due to AE. Our goal
was to measure HCV treatment rates in a large ethnically
diverse U.S. single-center cohort and changes from 2005-
2014. Methods: ICD-9 query identified 9207 patients and
individual charts were reviewed and confirmed HCV diagnosis
in 7105 patients. Of these, 929 received anti-HCV treatment
(P or P/R-based DAA-based). Results: Overall, treatment rate
was low (Figure). From 2005-2013, the proportion of treated
patients per all CHC patients with at least one clinical encounter
ranged 1.0-3.7% and 3.7-14.3% per new CHC patients.
Treatment rates per new HCV patients from 2005-07, 2008-
10, 2011-13, and 2014 were significantly different: 4.4%,
11.5%, 9.3%, and 46.5% (p