studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1123A
guidelines during the time of this study (including prioritizing
RX among those with advanced liver disease and non-genotype
1). Anticipation of more efficacious therapy (1 st generation
DAAs in development > 2007; and release of 2 nd generation
DAAs >2013) also influenced RX trends.
Disclosures:
The following authors have nothing to disclose: Carla V. Rodriguez, Kevin Rubenstein,
Haihong Hu, Michael A. Horberg
1872
Can Hepatitis C be eliminated from a high disease burden
country like Pakistan?
Saeed Hamid 1 , Huma Qureshi 2 , Asad A. Chaudhry 3 , Zaigham
Abbas 4 , Altaf Alam 5 , Altaf Baqir 6 , Javed I. Farooqi 7 , Muhammad
S. Memon 8 , Arif A. Nawaz 9 , Homie Razavi 10 , Devin M. Razavi-Shearer
11 , Amjad Salamat 12 , Masood Siddiq 13 , Arif Siddiqi 14 ,
Ghias Un Nabi Tayyab 15 , Muazzam Uddin 16 , Aasim Yusuf 17 ,
Bader F. Zuberi 18 , Aamir G. Khan 19 , Syed M. Jafri 1 ; 1 Medicine,
Aga Khan University, Karachi, Pakistan; 2 Pakistan Medical
Research Council, Karachi, Pakistan; 3 Liver Foundation, Gujranwala,
Pakistan; 4 Sindh Institute of Urology and Transplantation,
Karachi, Pakistan; 5 Skeikh Zayed Medical Institute, Lahore, Pakistan;
6 Nishtar Hospital, Multan, Pakistan; 7 Post Graduate Medical
Institute, Peshawer, Pakistan; 8 AIMS, Hyderabad, Pakistan;
9 Fatima Memorial Hospital, Lahore, Pakistan; 10 Center for Disease
Analysis, Denver, CO; 11 Center for Disease Analysis, Denver, Pakistan;
12 CMH, Rawalpindi, Pakistan; 13 Fauji Foundation Hospital,
Rawalpindi, Pakistan; 14 Allama Iqbal Medcial College, Lahore,
Pakistan; 15 PGMI, Lahore, Pakistan; 16 Bolan Medcial College,
Quetta, Pakistan; 17 Shaukat Khanum Hospital, Lahore, Pakistan;
18 Dow Medical College, Karachi, Pakistan; 19 Khyber Teaching
Hospital, Peshawer, Pakistan
Background: Pakistan has the highest number of individuals
with active hepatitis C virus (HCV) infection of all countries
except China, but unlike China, the total number of infections
in Pakistan is not declining. An estimated 4.2% of the general
population or 7,192, 900 persons were infected with HCV in
2014. Therefore, it is critical to assess the impact of strategies
that can tackle the ongoing transmission and manage the HCV
disease burden. Methods: Using a Markov model, the progression
of the HCV infected population was quantified and
the impact of different intervention strategies (prevention, treatment
and screening) was measured. The inputs were gathered
through a review of local and international publications, analysis
of local data, and discussions with an expert panel. Findings:
Elimination of HCV in 15 years is only feasible through
a combination of aggressive prevention, treatment and screening.
An estimated 230,000 new infections occur annually.
While 85,000 individuals are treated each year, the total number
of HCV infections is projected to increase to 7,529,200
by 2030. Contaminated medical equipment remains one of
the main risk factors, and education campaigns combined with
wide-scale availability of sterile equipment could reduce the
new infections by 50%. In addition, increasing treatment to
510,000 patients each year with high sustained viral response
therapies would reduce the total number of HCV infections to
less than 700,000 by 2030. Lower number of infections in 15
years would require the treatment of elderly and youth as well.
Implementation of this strategy would require an increase in
screening from 100,000 newly diagnosed cases to 600,000
annually. Conclusions: Elimination of HCV in Pakistan in 15
years is feasible but requires wide scale education, availability
of sterile equipment, screening and treatment. This strategy
would avert 220,000 liverrelated deaths and 116,000 new
hepatocellular carcinoma cases within 15 years.
Disclosures:
Homie Razavi - Management Position: Center for Disease Analysis
The following authors have nothing to disclose: Saeed Hamid, Huma Qureshi,
Asad A. Chaudhry, Zaigham Abbas, Altaf Alam, Altaf Baqir, Javed I. Farooqi,
Muhammad S. Memon, Arif A. Nawaz, Devin M. Razavi-Shearer, Amjad
Salamat, Masood Siddiq, Arif Siddiqi, Ghias Un Nabi Tayyab, Muazzam
Uddin, Aasim Yusuf, Bader F. Zuberi, Aamir G. Khan, Syed M. Jafri
1873
Dynamic change of α-fetoprotein, platelet counts and
aminotransferase-to-platelet ratio index (APRI) Predict
Hepatocellular Carcinoma in chronic hepatitis C patients
after antiviral therapy
Cheng-Kun Wu, Kuo-Chin Chang, Po-Lin Tseng, Sheng-Nan Lu,
Chien-Hung Chen, Jing-Houng Wang, Chuan-Mo Lee, Ming-Tsung
Lin, Chao-Hung Hung, Yi-Hao Yen, Tsung-Hui Hu; Division of Hepato-Gastroenterology,
Department of Internal Medicine, Kaohsiung
Chang Gung Memorial Hospital, Taiwan, Kaohsiung City, Taiwan
Background : Some patients who achieved viral eradication
still developed HCC in the future. It is very important to
accurately stratify the risks of HCC development in both SVR
and non-SVR groups. Less is known about the role of dynamic
change of serum markers on influence of HCC development.
Aims: To clarify the relationship between the dynamic change
of serum biomarkers and HCC risks Methods: We conducted
a large-scale, long-term cohort study with 2405 CHC patients
who have been treated with interferon (IFN) or pegylated interferon
(peg-IFN) plus ribavirin therapies enrolled. After exclusion
of patient with HCC development before treatment or
within 6 months after the end of therapy, loss to follow-up and
who didn’t have complete laboratory data, 1903 patients were
finally assessed for analysis. The collection of pre-treatment
hematological and biochemical data was completed before
IFN-based therapy. Post-treatment hematological and biochemical
data were collected at least 1 year after IFN-based therapy
and to the date of latest follow-up if possible. AFP data were
obtained more than 6 months prior to HCC development to
exclude HCC-related AFP elevation. Results: HCC developed
in 142 patients during follow-up. The entire cohort patients
had decreased AFP after IFN-based therapy irrespective of
viral eradication. Significantly decreased APRI was observed
in patients with SVR and non-SVR groups. The SVR patients
had increased platelet counts after antiviral therapy, whereas
non-SVR patients continued to have decreased platelet counts
during follow-up. On multivariate analysis, older age, liver cirrhosis,
lower hemoglobin level, non-SVR status, higher pre- and
post-treatment AFP (^15 ng/ml) and higher post-treatment APRI
(≥0.7) were significant risk factors for HCC. Risk factors for
HCC among patients with SVR were older age, liver cirrhosis
and higher pre- and post-treatment AFP; among those without
SVR, the risk factors were liver cirrhosis, lower hemoglobin
level, lower pre-treatment platelet