studies

1120A AASLD ABSTRACTS HEPATOLOGY, October, 2015
HCV molecular phylogenetic tree based on the NS5B sequences
1866
Hepatitis C Eradication with Sofosbuvir Leads to Significant
Metabolic Changes
Amilcar Morales, Manish B. Singla, Maria Sjogren, Dawn Torres;
Gastroenterology, Walter Reed National Military Medical Center,
Bethesda, MD
Infection with hepatitis C can cause metabolic complications,
including insulin resistance, hepatic steatosis and lipid abnormalities.
The purpose of this study was to assess the effect of
hepatitis C virus (HCV) eradication with sofosbuvir (SOF) regimens
on glycemic and lipid tests. This is a retrospective analysis
of HCV patients treated and cured with a SOF regimen (with
ribavirin [RBV], interferon or simeprevir) from January 2014 to
November 2014. Patients with HbA1c and lipid panels within
6 months before and 6 months after therapy were identified. In
those treated with a RBV regimen, HbA1c was obtained a minimum
of 3 months post therapy. Medical history, demographics,
HCV genotype, pre-therapy RNA, pre-therapy liver associated
enzymes, pre and post-therapy hemoglobin and liver biopsies
were included in our analysis. Patients with an increase in
therapy for hyperlipidemia or diabetes during our study period
were excluded. 106 patients were treated for HCV, of which
27 patients met inclusion criteria. 66.7% were male, 37.0%
were Caucasian, 18.5% were African American, 85.2% had
genotype 1, and 33.3% had stage 3 or 4 fibrosis on biopsy.
Mean age was 60.6 ± 5.2 years. Pre-treatment body-mass
index (BMI) did not differ from post-treatment BMI (27.9 ± 4.8
kg/m2 vs 27.4 ± 4.6 kg/m2, p = 0.662). No patients had
an increase in their HbA1c. HbA1c significantly decreased
with treatment of HCV (pretreatment 6.94 ± 1.05 mg/dL vs
post-treatment 6.15 ± 0.77 mg/dL, p = 0.012). There was
no correlation between decreases in HbA1c and changes in
hemoglobin in patients treated with RBV. 12 patients had diabetes,
and 2 patients had a decrease of their diabetic therapy
after eradication. 20 patients had pre- and post-treatment lipid
panels; there was a significant increase in LDL and total cholesterol
during the period of observation (LDL: 92.9 ± 26.8 mg/
dL vs 122.8 ± 36.2 mg/dL, p = 0.005; total cholesterol (TC)
163.2 ± 32.0 mg/dL vs 193.3 ± 45.7 mg/dL, p = 0.021).
Our study showed a significant drop in HbA1c up to 6 months
after eradication of HCV with a SOF regimen, which may be
related to a decrease in inflammatory cytokines and regulation
of insulin activation cascades. Our study is unique as most of
our patients had clinically significant HgA1C prior to HCV
therapy. Increased LDL and total cholesterol are likely due to
HCV infectious mechanism; lipid alterations are frequently
seen post therapy. This study suggests that physicians treating
HCV patients should reassess preventive medicine measures
after therapy, and the benefits of eradicating HCV may extend
beyond eliminating the effects of chronic liver inflammation.
Disclosures:
Maria Sjogren - Speaking and Teaching: Gilead, Bristol Myers
The following authors have nothing to disclose: Amilcar Morales, Manish B.
Singla, Dawn Torres
Disclosures:
The following authors have nothing to disclose: Shiqi Tao, Guangyu Huang, Li
Wang, Dengming He, Zehui Yan, Shitao Ding, Yunjie Dan, Cheng Xu, Xianghua
Zeng, Xiaohong Wang, Yuming Wang
1867
Hepatitis C and Renal Disease: Differences in Patient
Characteristics and Clinical Outcomes in the United
States
Senaka Peter 1 , Craig Solid 2 , Tanya Bovitz 2 , Haifeng Guo 2 , Allan
J. Collins 2 , Jean Marie Arduino 1 ; 1 Merck & Co., Inc, Kenilworth,
NJ; 2 Chronic Disease Research Group, Minneapolis, MN
Purpose: To describe characteristics and outcomes of US commercially-insured
patients with hepatitis C virus (HCV) infection
with and without renal impairment. Methods: In a cross-sectional
analysis, we identified an HCV cohort of patients aged
20 to 64 using Truven MarketScan claims database based
on ICD-9 diagnosis codes in 2011. Among this cohort, we
identified those with evidence of chronic kidney disease (CKD)
and end-stage renal disease (ESRD) by ICD-9 and CPT codes.
Adjusted logistic regression was used to estimate the odds of
clinical outcomes during a 1-year follow-up period. Results:
Of the 35,965 HCV patients identified, when compared with
HCV patients without evidence of renal impairment, those with
renal impairment were older, more often male, and had a
higher prevalence of most comorbidities, including hepatitis
B virus, cirrhosis, decompensated cirrhosis, and hepatocellular
carcinoma. Renal disease (either non-ESRD CKD or ESRD)
was associated with a significant increase in the rates of most
clinical outcomes studied, including heart failure (HF), sepsis,
pneumonia, stroke, AMI, and severe anemia with the need for
blood transfusion (Figure). When repeated using Medicare
data and HCV patients aged 65 years and older, similar results
were obtained (data not shown). Conclusions: Our findings
suggest that HCV patients with concurrent renal disease have a
significantly higher disease burden and likelihood of negative
health outcomes. These findings are of particular interest given
the efficacy of new HCV treatment options. Future studies can
assess how these new treatments may influence the likelihood
of adverse outcomes among HCV patients with renal impairment.