CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

2010-2019) and the characteristics of the cases were compared between these two periods, including the survival after HCC diagnosis. Results: 373 patients were included, 120 (32%) in the 1999-2009 period (1st period) and 253 (68%) in 2010-2019 (2nd period). In the 1st period, HCC diagnosis after SVR occurred in 12 (10.5%) patients compared with 66 (27%) in the 2nd period (p < 0.001). There was a greater proportion of HCC diagnosis by screening in the 2nd period [1st period, 46 (38%) patients vs 2nd period, 129 (51%); p = 0.02]. Likewise, there was a greater frequency of early diagnosis (BCLC stage 0-A) in the 2nd period [1st period, 25 (21%) patients vs 2nd period, 95 (37.5%); p = 0.001]. Sixty-four (53%) patients received some treatment strategy for HCC in 1999-2009 period, whereas 186 (73.5%) patients were treated for HCC in the 2nd period (p < 0.001). Furthermore, the proportion of curative therapies was higher in the 2nd period [1st period, 28 (23%) vs 2nd period, 109 (43%); p < 0.001]. The median survival (Q1-Q3) after HCC diagnosis was 6 (2.93-9.07) months in 1999- 2009 and 16 (9.9-22.1) months since 2010 (p = 0.035). Conclusion: The HCC clinical management in HIV-infected patients has improved in the last decade in Spain. Thus, the proportion of early diagnosis has increased, possibly due to an increasing rate of HCC detection by surveillance, resulting in a greater number of curative therapies. Consequently, the HCC survival in HIV-infected patients has considerably lengthened in recent years. 555 LIVER PATHOLOGY IN HIV-POSITIVE SUBJECTS UNDERGOING LIVER TRANSPLANTATION Roberto Rossotti 1 , Marco Merli 1 , Chiara Mazzarelli 1 , Stefano Di Sandro 1 , Mario L. Camozzi 1 , Giovanna Travi 1 , Raffaella Viganò 1 , Andrea Lauterio 1 , Emanuela Background: Liver transplantation (LT) represents the best therapeutic option for end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). Although LT in HIV+ showed similar survival rates compared to HIV- recipients, HCV recurrence and HCC severity seemmore harmful. Aim of this study is to compare pathologic features of livers explanted from HIV+ and HIV- patients. Methods: All subjects with HCV/HBV infection who underwent LT for ESLD or HCC from 2012 were retrospectively evaluated. Demographic and clinical features as well as macroscopic and histopathologic characteristics of explanted livers were collected. Descriptive statistics and non-parametric tests (Chi-square and Mann-Whitney U, as appropriate) were used. Results: 278 individuals, mainly men (83.1%), with a median age of 57 (IQR 52-63) years were included; 30 (10.8%) were HIV+. HCC was the indication for LT in 65.8% of cases. HIV+ subjects were younger (53 vs 58 years, p<0.00001), more commonly HCV+ after sustained virologic response achievement (43% vs 21%, p=0.0199) and less diabetic (10% vs 31%, p=0.0146). HIV+ subjects transplanted for ESLD showed a worse Child class (11 vs 10, p=0.0308) and a higher MELD score at the limit of significance (23 vs 17, p=0.0836), while no difference was observed for those transplanted for HCC. BCLC stage, alfa- fetoprotein level, portal vein thrombosis and previous bridging treatments were similar in the two groups. Table 1 shows features of included patients and explanted livers: HIV+ were comparable to HIV- individuals in terms of number and size of lesions, grading stage and vascular invasion. Histotype distribution resulted different, in particular for a higher presence of pseudoglandular pattern and cholangiocarcinoma in HIV- subjects. The presence of a capsule was more common in HIV- subjects, although they showed higher margin invasion. Of note, 30% of cases in both groups did not satisfy the so-called Milan criteria for LT eligibility. Conclusion: Despite a lower presence of traditional risk factors for HCC (older age, viremic HCV, diabetes), HIV+ individuals showed several macroscopic and pathologic features similar to HIV- recipients. Although no histopathologic feature has been included in prognostic staging systems because of poor reproducibility, it is recognized that trabecular and pseudoglandular HCC are associated with different gene signature mutations, thus possible different mechanisms in tumor development in the two populations could be alleged. Bonoldi 1 , Luca S. Belli 1 , Luciano G. De Carlis 1 , Massimo Puoti 1 1 ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Poster Abstracts

556 EPIDEMIOLOGICAL TREND OF CHRONIC HEPATITIS C IN SPAIN (2000- 2015): NATIONWIDE STUDY Irene Maté-Cano 1 , Alejandro Alvaro-Meca 2 , Paula Martínez-Román 1 , Óscar Brochado Kith 1 , Pablo Ryan3, Salvador Resino 1 , Verónica Briz 1 1 Institute of Health Carlos III, Madrid, Spain, 2 Universidad Rey Juan Carlos, Madrid, Spain, 3 Hospital Universitario Infanta Leonor, Madrid, Spain Background: Chronically Hepatitis C infected patients are at risk of progression to liver disease, developing liver fibrosis, compensated cirrhosis (CC), end-stage liver disease (ESLD), hepatocellular carcinoma (HCC), and finally dying, or need for liver transplantation (LT). The management of those patients generates a substantial economic cost on the National Health Services. Objective: To analyze the epidemiological trends of hospital admissions, intra-hospital deaths, and costs related to chronic hepatitis C (CHC) taking into account four major clinical stages: CC, ESLD, HCC and LT during the 21st century in Spain. Methods: Retrospective study in patients with CHC and a hospital admission in the Spanish Minimum Basic Data Set (2000-2015). The outcome variables were hospital admission, death, length of hospital stay (LOHS) and costs. ICD-9-CM codes were used for HCV diagnosis and HCV chronical clinical stages : CHC (070.44, 070.51, 070.54, 070.7x, or V02.62); compensated cirrhosis (571.2 or 571.5); end stage liver disease (572.2, 572.3, 572.4, 456.0 – 456.21, 530.7, 530.82, 578.X, 789.5, 567.23, 572.8, 54.9, 42.91, 44.91, 96.06, 573); hepatocellular carcinoma (155.x, 155.0, 155.1, 155.2); liver transplantation (996.82, V42.7, 50.5x). Results: 868,523 hospital admissions with CHC (25.5% CC, 25.3% ESLD, 8.6% HCC, and 2.5% LT) were identified. Overall rates of hospital admission and mortality increased from 2000-2003 to 2004-2007, but as of 2008, these rates stabilized and/or decreased. We found an upward trend for hospitalization percentage in CC (from 22.3% to 30%; p<0.001), ESLD (from 23.9% to 27.1%; p<0.001), HCC (from 7.4% to 11%; p<0.001), and LT (from 0.07% to 0.10%; p=0.003). We also found an upward trend for case fatality rate, except in ESLD (p=0.944). Gender and age influenced the evolution of hospitalization rates and mortality differently. LOHS showed a significant downward trend in all strata analyzed (p<0.001) (Fig1A). Cost per patient had a significant upward trend (p<0.001), except in LT, and a decrease from 2008-2011 to 2012-2015 in CC (p=0.025), HCC (p<0.001), and LT (p=0.050) was found (Fig1B). Global expedienture amounted up to 1200x106 euros in 2008-2011, decreasing slightly in 2012-2015 (Fig 1C). Conclusion: The initial upward trend of the disease burden in chronic hepatitis C has changed during the 21st century (2000-2015) in Spain, improving in many parameters after 2004-2007, particularly in the last calendar period (2012-2015)

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