Kevin C. Kin

High proportion of hepatitis C virus in community Asian American patients with non-liver-related complaints.

Goals and Background: Besides United States population born between 1945 and 1965, screening for hepatitis C virus (HCV) is not recommended for the general US population. However, HCV may be more prevalent in certain subgroups and screening may be warranted. The goal of this study was to examine the proportion of HCV in a large sample of community Asian American patients presenting for non–liver-related complaints. Study: We conducted a cross-sectional study of 1246 patients tested for hepatitis C virus antibodies (anti-HCV) referred to 2 gastroenterology clinics for non–liver-related gastrointestinal reasons between January 2001 and February 2011. We determined HCV status and patient history via electronic medical record review. Results: Of the 1246 study patients tested for anti-HCV, the majority were Asian (81.4%) and 29 Asian patients (2.9%) had positive anti-HCV. HCV proportion in the remaining 232 non-Asians (non-Hispanic whites and Hispanics) was 1.7%. Asians with positive anti-HCV were more likely to have had blood transfusions (31.0% vs. 6.6%, P<0.0001) or acupuncture (10.3% vs. 1.5%, P<0.0001). Of the 976 Asian patients with hepatitis B surface antigen testing, 38 (3.9%) also had detectable hepatitis B surface antigen. Conclusions: Among patients seen at community gastroenterology clinics for non–liver-related reasons, HCV proportion was 1.7% for non-Asians and 2.9% for Asians. Screening for HCV should be offered to high-risk patients presenting to gastroenterology clinics with unrelated gastrointestinal complaints.

Tenofovir monotherapy after achieving complete viral suppression on entecavir plus tenofovir combination therapy.

Objectives It is unclear whether patients with chronic hepatitis B with partial response to entecavir (ETV) who have achieved complete viral suppression (CVS) with ETV plus tenofovir (TDF) combination therapy maintain CVS if switched to TDF or ETV. Our goal was to examine virologic outcomes in such patients. Methods This is a retrospective cohort study of 57 ETV partial responders with chronic hepatitis B who showed CVS on ETV+TDF combination therapy, who were switched back to monotherapy with either ETV (n=16) or TDF (n=18), or continued on combination therapy (n=23). The majority of patients were Asian (91%) and male (65%), with a mean age of 41±12 years. Results The patients switched back to ETV had significantly higher rates of virologic breakthrough by 6 months after the switch compared with their TDF counterparts (88 vs. 39%, P=0.004). Patients who remained on ETV+TDF also had virologic breakthrough, due to either confirmed or suspected nonadherence. On multivariate analysis inclusive of age, sex, and hepatitis B virus DNA levels at initiation of combination therapy, ETV (compared with TDF) was found to be an independent predictor for virologic breakthrough (odds ratio 112.7, P=0.03), as well as duration of CVS of less than 12 months while on ETV+TDF (odds ratio 60.2, P=0.03). Conclusion TDF monotherapy, especially in those who have had CVS for at least 12 months on combination therapy, may be considered for some ETV partial responders who have achieved CVS with combination therapy, given the financial advantage and convenience of monotherapy.

Calcipotriene and betamethasone dipropionate for the topical treatment of plaque psoriasis

ABSTRACT Introduction: Psoriasis affects an estimated 2% of the worlds population, with higher rates in developed countries. 80% have mild-to-moderate disease and 50 to 80% have scalp involvement. Topical treatments are the mainstay of treatment. Areas covered: Two-compound calcipotriene and betamethasone dipropionate (BD) is a common topical combination therapy consisting of a vitamin D analogue and a corticosteroid. It comes in ointment, gel/suspension, and foam formulations. Phase II and III clinical trials have consistently shown the two-compound formulation to be effective and safe, with no clinically significant skin atrophy, calcium level changes, or adrenal suppression were seen. Topical scalp solution was also safe and effective in treating scalp psoriasis in pediatric populations. Expert commentary: Calcipotriene plus BD is more effective and safer than the individual ingredients in the same vehicle for treating body and scalp psoriasis. It should be considered a first line therapy for mild-to-moderate plaque psoriasis.

Su1286 Differences Between Community and Academic Cohorts of Patients With Chronic Hepatitis B (CHB) in the Development of Hepatocellular Carcinoma (HCC)

G A A b st ra ct s CI = 19%-27%) for patients receiving only supportive care, 39% (95% CI = 32%-46%) for those receiving liver-directed palliative therapy, 61% (95%CI = 51%-70%) for those undergoing partial hepatectomy, and 77% (95% CI = 71%-82%) for those having a liver transplantation. In multivariate analysis (Table), independent predictors for improved survival were non-White/non-Black race, palliative as well as surgical treatment. Independent predictors for poorer survival were age older than 65 and Black race (compared toWhites). Conclusions: In spite of improved opportunity for both effective palliative and curative therapies in the recent years, almost half of patients meeting Milan criteria are still not undergoing any therapy. In addition to assessing the efficacy and survival impact of current therapies, it is also important to focus on why so many patients diagnosed with HCC are not undergoing any treatment and reasons for continued existence of racial disparities. Early diagnosis through better screening protocols together with patient and physician education is crucial to achieve better outcomes. Multivariate Cox Proportional Hazards Model Assessing Factors Associated with Survival

Sa1003 High Prevalence of Hepatitis C Virus in Ethnically Diverse Community Patients With Non-Liver Related Gastrointestinal Complaints

disease, were excluded. Ten cases excluding the exceptions mentioned above were selected as healthy controls. The research was approved by the ethics commission of our hospital and all subjects gave their informed consent prior to inclusion in the study. The recommended dose of sonazoid was injected intravenously, and liver segment 5-6 and the right kidney were viewed simultaneously on video images. The region of interest (ROI) focused on the kidney, and the point at which 80% of the ROI in the kidney was colored was set as 0 s. The time course was then divided by color images as red up to 5 s and yellow after 5 s, to create At-PI for the liver parenchyma. Based on the At-PI, the ratio of red area to the colored area of the whole liver was calculated using Image J imaging processing software. The ratio of red area and assessment by liver biopsy (F factor) were analyzed for trends using the Jonckheere-Terpstra test, whereas multiple comparisons were performed using the SteelDwass test. Moreover, the usability of At-PI for diagnosis of liver fibrosis was examined by ROC curve analysis. The liver markers albumin (Alb), platelets (PLT), and prothrombin time (PT%), and the red area of each case were compared to determine the correlation coefficients and significance of differences. US was performed by a single technologist to ensure the same conditions in all cases. Cases in which there was difficulty in visualizing the liver because of intracostal narrowing, etc., were excluded. [Results] The ratio of red area in each F factor increased with progression of liver fibrosis. The ratio of red area increased significantly with Alb, PLT, PT% (R2=0.31, P=0.028/ R2=0.45, P=0.0003/ R2= 0.51, P=0.0003). [Conclusion] Hepatic arterialization accompanying with liver fibrosis of chronic hepatitis C could be visualized by analysis using At-PI. In addition, progression of hepatic arterialization and F factor were correlated with Alb, PLT, and PT%, which are representative parameters of liver function. At-PI is a useful and convenient method because it permits visualization of hepatic arterialization with clear color images, and may be feasible for clinical use in the evaluation of liver function and progression of liver fibrosis in patients with chronic hepatitis C.