CROI 2016 Abstract eBook
Abstract Listing
Poster Abstracts
530
Liver Stiffness Predicts Variceal Bleeding in HIV/HCV-Coinfected Patients Nicolás Merchante 1 ; Antonio Rivero-Juárez 2 ; FranciscoTéllez 3 ; Dolores Merino 4 ; María José Ríos 5 ; Guillermo Ojeda-Burgos 6 ; Mohamed Omar Mohamed-Balghata 7 ; Juan Macías 1 ; Antonio Rivero 8 ; Juan A. Pineda 1 ; for the HEPAVIR-Cirrhosis Study Group 1 Hosp Universitario de Valme, Sevilla, Spain; 2 IMIBIC, Córdoba, Spain; 3 Hosp La Línea de la Concepción (AGS Campo de Gibraltar), La Línea de la Concepción, Spain; 4 Complejo Hospario de Huelva, Huelva, Spain; 5 Hosp Universitario Virgen de la Macarena, Seville, Spain; 6 Hosp Universitario Virgen de la Victoria, Málaga, Spain; 7 Complejo Hospario de Jaén, Jaén, Spain; 8 Hosp Universitario Reina Sofía, Córdoba, Spain Background: A previous study has shown that a liver stiffness (LS) < 21 kiloPascals (kPa) has a 100% negative predictive value (NPV) to exclude the presence of esophagueal varices (EV) at risk of bleeding in HIV/HCV-coinfected patients. Consequently, upper gastrointestinal endoscopy (UGE) for the screening of EV could be avoided in these patients. However, this strategy has not been widely accepted due to concerns about its safety. Our objective was to assess the predictive value of LS to predict the risk of variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis. Methods: Prospective cohort study of 461 HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, based on the presence of LS ≥ 14 kPa, and no previous decompensation of liver disease. All patients underwent a UGE for the screening of EV at entry in the cohort before November 2009. From this date, UGE was not recommended by the cohort protocol in patients with LS < 21 kPa. The time from diagnosis of cirrhosis to the emergence of a variceal bleeding episode, as well as the predictors of this outcome were evaluated. Results: At baseline, 206 (45%) had a LS < 21 kPa whereas 255 (55%) had a LS ≥ 21 kPa. In 311 (67%) patients, at least 1 UGE was done. EV at risk of bleeding were present in 26 (8%) of them. During follow-up, 417 UGE were performed in 311 patients. The median (IQR) elapsed time between LS assessment and UGE examination was 21 (-12, 78) days. EV at risk of bleeding were present in 2 (2%) UGE examinations of patients with a LS < 21 kPa whereas it were found in 43 (13%) UGE examinations of patients with a LS ≥ 21 kPa (p=0.008). These two patients with a LS < 21 kPa and high-risk EV harboured a LS of 20.2 and 20.9 kPa, respectively. After a median (IQR) follow-up of 49 (24-68) months, 16 (3.5%, 95% confidence interval: 1.8-5.1) patients developed a first variceal bleeding episode. In all cases, baseline LS was ≥ 21 kPa. Thus, the NPV of a LS < 21 kPa to predict a bleeding episode during follow-up was 100%. At the moment of the bleeding episode, LS was also above this threshold. Conclusions: Baseline LS identifies HIV/HCV-coinfected patients with compensated cirrhosis with a very low risk of presenting a variceal bleeding episode. In fact, no individual with baseline LS < 21 kPa developed this outcome. Our results confirm that UGE can be safely spared in patients with LS < 21 kPa, provided that LS maintains below this threshold.
LS < 21 kPa
LS ≥ 21 kPa
p=0.001
Probability
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531
Hepatitis C Screening and Linkage to Care at a Comprehensive Health System Kassem Bourgi 1 ; Indira Brar 2 ; Kimberly Baker-Genaw 2 1 Henry Ford Hosp/Wayne State Univ, Troy, MI, USA; 2 Henry Ford Hosp/Wayne State Univ, Detroit, MI, USA Background: The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force (USPTF) recommend screening for Hepatitis C (HCV) among patients born between 1945 and 1965. With the advent of novel highly effective therapies, we evaluated the current HCV screening rates along with linkage to care for patients with active disease. Methods: We used the Henry Ford Health System records to create a retrospective cohort of patients born between 1945 - 1965 seen at 21 internal medicine clinics between July 2014 and June 2015. Patients previously screened for HCV and those with established disease were excluded. We studied patient socio-demographic and medical conditions along with provider-specific factors associated with likelihood of screening. Patients who tested positive were reviewed to assess appropriate linkage to care and treatment. Results: 47,304 patients were included in our study cohort and 40,561 patients met inclusion criteria. A total of 8,657 (21.3%) were screened. Screening rates were found to be higher among men (p < 0.001) and African Americans (p <0.001). The rates were lower in patients with multiple comorbidities (p <0.001) and fewer clinic visits (p <0.001). Practice setting influenced screening rates as patients seen in residency teaching clinics were more likely to be screened (p <0.001). Patient electronic health engagement was associated with higher screening rates (p <0.001).
Poster Abstracts
Among patients who were screened, 117 (1.4 %) patients tested positive. After excluding patients without active viremia, 78% of patients were referred to a Hepatitis C specialist and 50%were successfully evaluated. On follow-up, 27% of HCV positive patients received treatment with Direct Acting Anti-virals. Medicaid patients were less likely to be treated (p <0.05) along with a trend towards a decrease in likelihood of treatment among patients with lower income. Electronic health engagement was again a significant factor that increased the odds of treatment (p <0.05). Conclusions: HCV screening rates are suboptimal with a significant influence of sociodemographic and provider-specific factors. Furthermore, patients who tested positive had inadequate linkage to care with a major disadvantage for Medicaid and low income patients. This accentuates the need for a more robust and equitable care delivery system. The study also highlights a promising role for patient’s engagement in electronic health portals through active linkage at multiple phases of the care cascade.
207
CROI 2016
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