Session Type: 30min ePoster Review
Session Title: 30min ePoster Review
Authors(s): C. Grant (1, 2), J. Dillon (1), C. Bannan (1), M. Coghlan (1), C. Williamson (1), M. Broderick (1), C. Murray (1), G. Farrell (1), C. Bergin (1, 2)
Authors Affiliations(s): (1) St. James's Hospital, GUIDe, Ireland, (2) Trinity College Dublin, Ireland
Background:
The European Association for the Study of the Liver recommend lifelong, 6-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) following successful Hepatitis C virus (HCV) treatment in patients with a baseline Metavir score of F3 (Fibroscan® score 10kPa) or above.
However, in a large cohort study, Kanwal and colleagues identified a subgroup of non-cirrhotic patients whose post-treatment HCC incidence was higher than the accepted threshold at which surveillance is cost-effective. This subgroup was non-cirrhotic patients whose baseline Fib-4 score was >3.25, or else between 1.45 and 3.25 with an APRI score >1.5. The authors proposed this subgroup may benefit from surveillance.
Also identified was a subgroup of cirrhotic patients whose HCC incidence was lower than the same threshold. This subgroup was patients who had persistently low FIB-4/APRI scores at baseline and one year post-treatment. The authors postulated that surveillance may not be warranted in this subgroup.
We sought to identify and enumerate these subgroups in our cohort, in which a majority of patients prescribed DAAs are HIV co-infected (versus 5.9% observed by Kanwal et al).
Methods:We performed a retrospective review of all patients prescribed DAAs at our clinic from 2015 to 2018. The minimum duration of follow up was 2 years.
Results:Over 4 years, 404 DAA courses were prescribed in 392 patients. At baseline, 113 patients (28.8%) had a Fibroscan® score ≥10kPa. Of those completing DAAs, 200 of 201 (99.5%) HIV co-infected patients achieved SVR, versus 166 of 177 (93.8%) mono-infected patients (p = 0.0016) (Table 1).
16 patients (4.4% of patients who achieved SVR) had a Fibroscan® score <10kPa, but a high FIB-4/APRI at baseline. 15 of 16 patients were not undergoing surveillance.
For the second group, we identified 34 cirrhotic patients (9.3% of patients who achieved SVR) who had persistently low Fib-4/APRI scores.
No patient from either of these groups has a documented diagnosis of HCC (median follow-up: 46 and 56 months, respectively).
Conclusions:An additional 4.4% of our post-treatment patients may warrant ongoing HCC surveillance. Surveillance may not be cost-effective in 9.3% of our post-treatment patients if the findings of Kanwal et al. bear out.
Keyword(s): Co-infection, Direct acting antivirals, SurveillanceSession Type: 30min ePoster Review
Session Title: 30min ePoster Review
Authors(s): C. Grant (1, 2), J. Dillon (1), C. Bannan (1), M. Coghlan (1), C. Williamson (1), M. Broderick (1), C. Murray (1), G. Farrell (1), C. Bergin (1, 2)
Authors Affiliations(s): (1) St. James's Hospital, GUIDe, Ireland, (2) Trinity College Dublin, Ireland
Background:
The European Association for the Study of the Liver recommend lifelong, 6-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) following successful Hepatitis C virus (HCV) treatment in patients with a baseline Metavir score of F3 (Fibroscan® score 10kPa) or above.
However, in a large cohort study, Kanwal and colleagues identified a subgroup of non-cirrhotic patients whose post-treatment HCC incidence was higher than the accepted threshold at which surveillance is cost-effective. This subgroup was non-cirrhotic patients whose baseline Fib-4 score was >3.25, or else between 1.45 and 3.25 with an APRI score >1.5. The authors proposed this subgroup may benefit from surveillance.
Also identified was a subgroup of cirrhotic patients whose HCC incidence was lower than the same threshold. This subgroup was patients who had persistently low FIB-4/APRI scores at baseline and one year post-treatment. The authors postulated that surveillance may not be warranted in this subgroup.
We sought to identify and enumerate these subgroups in our cohort, in which a majority of patients prescribed DAAs are HIV co-infected (versus 5.9% observed by Kanwal et al).
Methods:We performed a retrospective review of all patients prescribed DAAs at our clinic from 2015 to 2018. The minimum duration of follow up was 2 years.
Results:Over 4 years, 404 DAA courses were prescribed in 392 patients. At baseline, 113 patients (28.8%) had a Fibroscan® score ≥10kPa. Of those completing DAAs, 200 of 201 (99.5%) HIV co-infected patients achieved SVR, versus 166 of 177 (93.8%) mono-infected patients (p = 0.0016) (Table 1).
16 patients (4.4% of patients who achieved SVR) had a Fibroscan® score <10kPa, but a high FIB-4/APRI at baseline. 15 of 16 patients were not undergoing surveillance.
For the second group, we identified 34 cirrhotic patients (9.3% of patients who achieved SVR) who had persistently low Fib-4/APRI scores.
No patient from either of these groups has a documented diagnosis of HCC (median follow-up: 46 and 56 months, respectively).
Conclusions:An additional 4.4% of our post-treatment patients may warrant ongoing HCC surveillance. Surveillance may not be cost-effective in 9.3% of our post-treatment patients if the findings of Kanwal et al. bear out.
Keyword(s): Co-infection, Direct acting antivirals, Surveillance
Session Type: 30min ePoster Review
Session Title: 30min ePoster Review
Authors(s): C. Grant (1, 2), J. Dillon (1), C. Bannan (1), M. Coghlan (1), C. Williamson (1), M. Broderick (1), C. Murray (1), G. Farrell (1), C. Bergin (1, 2)
Authors Affiliations(s): (1) St. James's Hospital, GUIDe, Ireland, (2) Trinity College Dublin, Ireland
Background:
The European Association for the Study of the Liver recommend lifelong, 6-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) following successful Hepatitis C virus (HCV) treatment in patients with a baseline Metavir score of F3 (Fibroscan® score 10kPa) or above.
However, in a large cohort study, Kanwal and colleagues identified a subgroup of non-cirrhotic patients whose post-treatment HCC incidence was higher than the accepted threshold at which surveillance is cost-effective. This subgroup was non-cirrhotic patients whose baseline Fib-4 score was >3.25, or else between 1.45 and 3.25 with an APRI score >1.5. The authors proposed this subgroup may benefit from surveillance.
Also identified was a subgroup of cirrhotic patients whose HCC incidence was lower than the same threshold. This subgroup was patients who had persistently low FIB-4/APRI scores at baseline and one year post-treatment. The authors postulated that surveillance may not be warranted in this subgroup.
We sought to identify and enumerate these subgroups in our cohort, in which a majority of patients prescribed DAAs are HIV co-infected (versus 5.9% observed by Kanwal et al).
Methods:We performed a retrospective review of all patients prescribed DAAs at our clinic from 2015 to 2018. The minimum duration of follow up was 2 years.
Results:Over 4 years, 404 DAA courses were prescribed in 392 patients. At baseline, 113 patients (28.8%) had a Fibroscan® score ≥10kPa. Of those completing DAAs, 200 of 201 (99.5%) HIV co-infected patients achieved SVR, versus 166 of 177 (93.8%) mono-infected patients (p = 0.0016) (Table 1).
16 patients (4.4% of patients who achieved SVR) had a Fibroscan® score <10kPa, but a high FIB-4/APRI at baseline. 15 of 16 patients were not undergoing surveillance.
For the second group, we identified 34 cirrhotic patients (9.3% of patients who achieved SVR) who had persistently low Fib-4/APRI scores.
No patient from either of these groups has a documented diagnosis of HCC (median follow-up: 46 and 56 months, respectively).
Conclusions:An additional 4.4% of our post-treatment patients may warrant ongoing HCC surveillance. Surveillance may not be cost-effective in 9.3% of our post-treatment patients if the findings of Kanwal et al. bear out.
Keyword(s): Co-infection, Direct acting antivirals, SurveillanceSession Type: 30min ePoster Review
Session Title: 30min ePoster Review
Authors(s): C. Grant (1, 2), J. Dillon (1), C. Bannan (1), M. Coghlan (1), C. Williamson (1), M. Broderick (1), C. Murray (1), G. Farrell (1), C. Bergin (1, 2)
Authors Affiliations(s): (1) St. James's Hospital, GUIDe, Ireland, (2) Trinity College Dublin, Ireland
Background:
The European Association for the Study of the Liver recommend lifelong, 6-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) following successful Hepatitis C virus (HCV) treatment in patients with a baseline Metavir score of F3 (Fibroscan® score 10kPa) or above.
However, in a large cohort study, Kanwal and colleagues identified a subgroup of non-cirrhotic patients whose post-treatment HCC incidence was higher than the accepted threshold at which surveillance is cost-effective. This subgroup was non-cirrhotic patients whose baseline Fib-4 score was >3.25, or else between 1.45 and 3.25 with an APRI score >1.5. The authors proposed this subgroup may benefit from surveillance.
Also identified was a subgroup of cirrhotic patients whose HCC incidence was lower than the same threshold. This subgroup was patients who had persistently low FIB-4/APRI scores at baseline and one year post-treatment. The authors postulated that surveillance may not be warranted in this subgroup.
We sought to identify and enumerate these subgroups in our cohort, in which a majority of patients prescribed DAAs are HIV co-infected (versus 5.9% observed by Kanwal et al).
Methods:We performed a retrospective review of all patients prescribed DAAs at our clinic from 2015 to 2018. The minimum duration of follow up was 2 years.
Results:Over 4 years, 404 DAA courses were prescribed in 392 patients. At baseline, 113 patients (28.8%) had a Fibroscan® score ≥10kPa. Of those completing DAAs, 200 of 201 (99.5%) HIV co-infected patients achieved SVR, versus 166 of 177 (93.8%) mono-infected patients (p = 0.0016) (Table 1).
16 patients (4.4% of patients who achieved SVR) had a Fibroscan® score <10kPa, but a high FIB-4/APRI at baseline. 15 of 16 patients were not undergoing surveillance.
For the second group, we identified 34 cirrhotic patients (9.3% of patients who achieved SVR) who had persistently low Fib-4/APRI scores.
No patient from either of these groups has a documented diagnosis of HCC (median follow-up: 46 and 56 months, respectively).
Conclusions:An additional 4.4% of our post-treatment patients may warrant ongoing HCC surveillance. Surveillance may not be cost-effective in 9.3% of our post-treatment patients if the findings of Kanwal et al. bear out.
Keyword(s): Co-infection, Direct acting antivirals, Surveillance