studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1087A
recurrence. The following were categorized as justified: 440
(6.4%) patients with F2 fibrosis; 661(10%) patients with F0-F1
fibrosis fall in the deferrable category. Hence, in this large
cohort, treatment should overall be prioritized in 3417 (50%)
patients (HCV Gt 1: 66%; Gt 2: 10%; Gt 3: 12%; Gt 4: 7%),
can be justified in 440 (6.4%) and deferred in 661 (9.6%)
patients, while it is not indicated in 2313 (33.8%) patients due
to severe co-morbidities or age older than 75 years. By comparison,
the prioritization algorithm endorsed by AIFA (the Italian
Medicines Agency), mostly based on fibrosis alone, which
dictates reimbursement of DAA in Italy, would allow treatment
of only 2827 (41%) of these patient cohort. Conclusion: Among
patients with chronic hepatitis C, allocation of DAA according
to priority rules linked to a perceived need for more prompt
treatment will allow access to therapy to 40-55% of patients.
There is a clear need for a validated predictive model to assess
the impact of delaying treatment or not treating the remaining
patients.
Disclosures:
Maurizia R. Brunetto - Speaking and Teaching: Roche, Gilead, Schering-Plough,
Bristol-Myers Squibb, Abbott, Roche, Gilead, MSD, Novartis
Mario Rizzetto - Advisory Committees or Review Panels: Merck, Janssen, BMS
Alfredo Di Leo - Speaking and Teaching: Abbvie, MSD, Gilead, Roche, Italfarmaco,
THD, CMD pharmalimited
Giovanni Raimondo - Speaking and Teaching: BMS, Gilead, Roche, Merck,
Janssen, Bayer, MSD
Carlo Ferrari - Advisory Committees or Review Panels: Gilead, Roche, Abbvie,
BMS, Merck, Arrowhead; Grant/Research Support: Gilead, Roche, Janssen
Gloria Taliani - Speaking and Teaching: ROCHE, Merck, BMS, Gilead, Jannsen,
Novartis, AbbVie
Luchino Chessa - Board Membership: Abbvie; Speaking and Teaching: BMS,
Jannsen
Pietro Andreone - Advisory Committees or Review Panels: Janssen-Cilag, Gilead,
MSD/Schering-Plough, Abbvie; Speaking and Teaching: Gilead, BMS
Erica Villa - Advisory Committees or Review Panels: MSD, Abbvie, GSK, Gilead;
Speaking and Teaching: Novartis
Giovanni B. Gaeta - Advisory Committees or Review Panels: Janssen, Merck,
Abbvie, Roche; Speaking and Teaching: BMS, Gilead
Alfredo Alberti - Advisory Committees or Review Panels: Merck, roche, Gilead,
Merck, roche, Gilead, Merck, roche, Gilead, Merck, roche, Gilead; Grant/
Research Support: Merck, gilead, Merck, gilead, Merck, gilead, Merck, gilead;
Speaking and Teaching: novartis, BMS, novartis, BMS, novartis, BMS, novartis,
BMS
Massimo Puoti - Advisory Committees or Review Panels: GSK, Abbott, Janssen,
MSD, Roche, Gilead Sciences, Novartis, GSK, Abbott, Janssen, MSD, Roche,
Gilead Sciences, Novartis, GSK, Abbott, Janssen, MSD, Roche, Gilead Sciences,
Novartis, GSK, Abbott, Janssen, MSD, Roche, Gilead Sciences, Novartis; Speaking
and Teaching: BMS, BMS, BMS, BMS
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: Loreta A. Kondili, Stefano Rosato,
Maria Giovanna Quaranta, Liliana E. Weimer, Loredana Falzano, Alessandra
Mallano, Maria Elena Tosti, Maurizio Massella, Anna Linda Zignego, Pierluigi
Blanc, Antonio Gasbarrini, Elke M. Erne, Giovanna Fattovich, Maria Vinci, Francesco
P. Russo, Teresa A. Santantonio, Guglielmo Borgia, Gabriella Verucchi,
Carmine Coppola, Marcello Persico, Liliana Chemello, Vincenzo De Maria, Raffaele
Bruno, Massimo Andreoni, Marco Marzioni, Stefano Vella, Antonio Craxi
1803
Hepatitis E in haematological and rheumatological
patients, a multicentre study
Johann von Felden 1 , Laurent Alric 2 , Vincent Mallet 11 , Ansgar W.
Lohse 1 , Paul Schnitzler 3 , Heiner Wedemeyer 4 , Christoph Hoener
zu Siederdissen 4 , Maria Teresa Giordani 5 , Celia Aitken 6 , Jan
Cornelissen 10 , Dominik Bettinger 7 , Robert Thimme 7 , Jean-Marie
Peron 8 , Sven Pischke 1 , Robert A. de Man 9 ; 1 Gastroenterology,
Hepatology, and Infectious Diseases, University Medical Centre
Hamburg, Hamburg, Germany; 2 Unité de recherche clinique sur
les hépatites virales, Médecine Interne-Pôle Digestif, CHU Purpan,
Toulouse, France; 3 Virology, University Hospital, Heidelberg, Germany;
4 Gastroenterology, Hepatology, Endocrinology, Hannover
Medical School, Hannover, Germany; 5 Infectious and Tropical
Diseases Unit, San Bartolo Hosptial, Vincenza, Italy; 6 Virology,
NHS Greater Glasgow and Clyde, Glasgow, United Kingdom;
7 Dept. Internal Medicine II, University Medical Centre Freiburg,
Freiburg, Germany; 8 Gastro-entérologie et hépatologie, Médicine
Interne-Pôle Digestif, Toulouse, France; 9 Hepatology, Gastroenterology,
and Infectious Diseases, Erasmus Medical Center,
Rotterdam, Netherlands; 10 Dept. Haematology, Erasmus Medical
Center, Rotterdam, Netherlands; 11 Unité d’hépatologie, Université
Paris Descartes, Paris, France
Background Acute and chronic hepatitis E (HEV) in solid
organ transplant recipients has been frequently described
but the knowledge about HEV in patients with underlying
haematological or rheumatological disease is limited. Methods
We investigated retrospectively the clinical course of 47
HEV infections in haematological (n=38) or rheumatological
patients (n=9) within a multicentre observational study. Results
Patients suffered from the following diseases: lymphoma n=17,
myeloma n=3, chronic leukemia n=7, acute leukemia n=4,
other haematological diseases n=7, rheumatoid arthritis, n=5,
other rheumatological diseases=4. All patients received standard
immunosuppressing therapy (calcineurin inhibitors: n=8,
R-CHOP/R-Benda/R-ICE: n=7, cyclophosphamide n=7, other:
n=28). 12/47 patients were stem cell transplant recipients
(mean date of transplantation: 832 days before positive testing
for HEV, range 20-4835 days). All patients tested positive for
HEV RNA, and had laboratory signs of viral hepatitis (mean
ALT 866 IU/ml, range 66-2849 IU/ml), while peak bilirubin
was mean 7.3 mg/dl and peak creatinine was 90.2 mmol/l.
All but one HEV infection had been acquired in Europe (1
from Indonesia). Treatment with ribavirin (RBV) was initiated
in 23/47 patients (5-22mg/kg bodyweight, duration: 1-32
weeks, mean 14 weeks). Start of treatment ranged from immediately
at the time of diagnosis up to 24 weeks after first detection
of HEV (mean 9 weeks). 14/23 treated patients cleared
the infection (61%), four patients (17%) failed to achieve viral
clearance, one died (from deteriorating GvHd under treatment),
two are still treated at the time of writing. 19 of the 24
non-treated patients (79%) cleared the infection spontaneously,
three died (two died directly after hepatitis E diagnosis from
leukemia associated problems, one from GvHd), two are still
under observation. RBV vs. untreated patients did not differ
in peak ALT levels (RBV 836 IU/l, range 66-2775 IU/l vs. no
treatment 931 IU/l, range 72-2849 IU/l), restitution of ALT
after HEV infection (RBV 28 IU/l, range 11-85 IU/l (one patient
with 937 IU/l) vs. no treatment 27 IU/l, range 13-76 IU/l)
or in duration of HEV infection (RBV 27.1 weeks vs. no treatment
27.5 weeks). ALT levels normalized in 37/47 patients
(79%). Conclusion Chronic HEV infection is not restricted to
solid organ transplant recipients but can also occur in immunosuppressed
patients with haematological or rheumatological
diseases. Ribavirin seems to be an efficient and safe treatment
option. However, parameters that predict spontaneous clear-