Low HCV Treatment Rates after a Liver Biopsy O.M Adeyemi , B. Attar, G. Huhn , D. Wolen , M. Gallagher, R. Goldberg CORE Center, Stroger Hosp. of Cook County, Chicago, IL and Rush Medical College,Chicago , IL. 48 th ICAAC/IDSA meeting, Washington, DC October 25-28, 2008. V-1637.
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O.M Adeyemi, B. Attar, G. Huhn, D. Wolen, M. Gallagher, R. Goldberg
CORE Center, Stroger Hosp. of Cook County, Chicago, IL and Rush Medical College,Chicago, IL.
48th ICAAC/IDSA meeting, Washington, DC October 25-28, 2008
V-1637Predictors of HCV treatment post Liver biopsy
Background-At the CORE center in Chicago, despite an on-site hepatitis clinic and access to HCV therapy regardless of insurance status, few HCV+ genotype (gn) 1 pts are treated. A liver biopsy (LB) is performed after >2 hepatitis clinic visits in gn1 pts who are treatment (Rx) candidates. The aims of this study were (1) to determine the rate of HCV Rx post LB and (2) delineate the reasons for non-treatment post LB.
Methods- Retrospective review of the CORE hepatitis database to identify all HCV+ genotype 1 pts (with or without HIV co-infection), who had a LB. LB Staging was done using Batts-Ludwig scale: F0 (no fibrosis) to F4 (cirrhosis).
Results-Between 8/01 and 8/06, 163 HCV+gn1 pts had a LB performed; 83 (51%) were HIV+ (mean CD4, cells/mm 428). The mean age was 47yrs; 75% were male, 63% African American (AA), 20% Hispanic, 16%Caucasian. On LB, 58% had Fibrosis >F2 and 11% F4. Overall, 61/163 [37%] pts received HCV therapy post LB; with no impact of HIV status. Women were more likely to receive Rx post LB (50% vs 32%, p=0.05) and AA were less likely (27% vs 50% p=0.01) to receive Rx. Pts were more likely to receive Rx if they had; fibrosis>F2 48% vs 22% (p=0.001) or cirrhosis 70% vs 34% (p=0.001). When only pts with >F2 were considered Rx eligible, then 46/93 [49%] of eligible pts received Rx. On multivariate analysis, independent predictors of Rx were race (p=0.01) and fibrosis >F2 (p=0.001). There were delays in Rx initiation with 45% starting Rx >1yr post LB; women were more likely to start Rx later, >1yr (65% vs 35% p=0.05) post LB. Reasons for non-Rx were; mild fibrosis F0-F1 (53%), pt declined (20%), lost to follow up (LTFU) (19%) and other (8%). There were 2 liver related deaths in untreated pts (both HIV+). In the 47 untreated pts with >F2 fibrosis, HIV+ pts were more likely to decline Rx (57% vs 27%) and less likely to be LTFU (23% vs 59%) (p=0.04) when c/w HIV- pts. In the 61 Rx pts, sustained virologic response (SVR) was 26% (14%HIV+ vs 38% HIV-) (p=0.04).
Conclusions; In HCV+ gn1 pts, only 37% overall and 49% of those with significant fibrosis (>F2) received HCV Rx post LB with almost half starting therapy >1yr post biopsy. Most untreated HIV co-infected pts, continued to follow up in the hepatitis clinic post LB, but declined Rx underscoring the urgent need for more effective and better tolerated therapies for HCV.
Table 1- Demographics of study population ( n=163)
Fig 2- Reasons for non treatment post- liver biopsy
N=102; 52HIV+, 50HIV-
Fig 3- Major reasons for non-treatment in pts with significant fibrosis >F2 on histology (stratified by HIV status)
All values mean+2SD
Table 2- Liver biopsy findings Batts-Ludwig scale F0-F4 (n=163)
Other reasons included-: decompensated liver disease, ongoing alcohol or drug abuse, medical or psych C/I
2 deaths occurred in this group from decompensated liver disease (both patients HIV+)
Time to HCV Treatment Initiation after a liver biopsy
There were no significant differences in liver histology between HIV+ and HIV- patients
Fig 1; Sustained Virologic response (SVR) in the 61 treated Patients
Corresponding author: Oluwatoyin M Adeyemi, MD
Email address: firstname.lastname@example.org
All pts received Pegylated Interferon+ Ribavirin