2208. Fibrosis Surveillance by Transient Elastography in Patients with Untreated Hepatitis C Infection
Session: Poster Abstract Session: Hepatitis A, B, and C
Saturday, October 6, 2018
Room: S Poster Hall

Background: Despite the widespread availability of curative HCV therapy and recommendations to consider all HCV infected patients (pts) for treatment, many remain untreated. Illinois Medicaid continues to restrict HCV therapy to pts with stage F3 or F4 fibrosis. In our Hepatitis Clinic, untreated pts are counseled and scheduled for follow up scans at 6-12 month.  This keeps pts engaged in care and allows us to identify progression of liver disease. Our study aims were to describe fibrosis assessments in HCV pts and identify predictors of fibrosis progression among untreated HCV-infected pts.

Methods: HCV infected untreated pts with >1 transient elastography by Fibroscan® between April 2014 and March 2018 and with a baseline scan ≤Stage 2 fibrosis were included in the study. All scans were done by certified operators; 793 (63%) done by 1 operator. Fibroscan criteria; Stage 0-1 fibrosis; <7.0KPa and Stage 2 fibrosis; 7.1-9.4KPa.

Results: 545 pts had a total of 1260 scans. Median age of 59 years, 64% male, 70% African American, 23% White and 14% Hispanic. 196 (36%) HIV+. 399 (73%) pts had 2 scans, 127 (23%) pts had 3 scans and 14 (4%) pts had ≥4 scans. Median time between scans was 12.8 months (range 9.2-17.3 months) with a median duration of 12.8, 24.5 and 40 months between the baseline and 2nd, 3rd or 4th scans respectively. Median baseline score was 6.4 (range 5.3-7.7); 65.3% F0-F1 and 34.7% F2.  At last scan, 62% remained at the same stage, 23% had moved 1 stage and 15% regressed from stage 2 to stage 1. In the subset who regressed, scores went from 7.8 to 6.1. 

Conclusion: For the majority of HCV+ pts with mild liver fibrosis at baseline, fibrosis severity remained essentially flat.  Progression to moderate/severe fibrosis occurred more often among pts with stage 2 fibrosis at baseline. Engagement in care remains important to identify pts with fibrosis progression as advocacy to ensure access to curative treatment for all continues.

Table 1.  Proportion of Patients with ≥F3 at Follow Up Stratified by Baseline Stage

Baseline Fibrosis

N (%) ≥F3 at Follow Up 1

(median time to scan)

N (%) ≥F3 at Follow Up 2

(median time to scan)

N (%) ≥F3 at Follow Up 3

(median time to scan)

Stage 0-1

 

13 (5.1%)

17.0 months

3 (3.4%)

19.0 months

0 (0%)

Stage 2

 

41 (30.1%)

12.7 months

11 (25%)

20.1 months

2 (1.5%)

26.1 months

 

Oluwatoyin Adeyemi, MD1, Kerianne Burke, MPH2, Crystal Winston, BA2, Sara Markham, BS3, Dan Taussig, MPH2, Benjamin Go, MD4 and Greg Huhn, MD5, (1)Ruth M Rothstein CORE Center, Cook County Health and Hospitals System (CCHHS) and Rush University Medical Center, Chicago, IL, (2)Ruth M Rothstein CORE Center, CCHHS, Chicago, IL, (3)Ruth M. Rothstein CORE Center, Chicago, IL, (4)Cook County Health and Hospitals System, Chicago, IL, (5)The Ruth M. Rothstein Core Center - Rush University Medical Center, Chicago, IL

Disclosures:

O. Adeyemi, None

K. Burke, None

C. Winston, None

S. Markham, None

D. Taussig, None

B. Go, None

G. Huhn, Gilead: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient . ViiV Healthcare: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient . Janssen: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient . Theratechnologies: Scientific Advisor , Consulting fee . Proteus: Grant Investigator , Grant recipient .

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.