May 18th


Abstract ID: W1699


Serum Adiponectin Concentration in Patients With Hepatitis C Virus


K. Furuta, T. Mishiro, T. Miyake, S. Sato, K. Adachi, Y. Kinoshita



Adiponectin, an adipocyte-derived hormone, insulin-sensitizing, and anti-atherosclerotic properties. Its serum concentration is regulated by the balance between secretion from adipocytes and excretion by the kidney and liver. Adiponectin is also known to protect hepatocytes from injury directly via its receptors on their surface, and administration of CCl4 to adiponectin-knockout mice is reported to cause more severe liver damage than administration to wild-type animals. In patients with liver cirrhosis, the serum adiponectin concentration is known to be elevated due to decreased hepatic extraction of adiponectin from the circulation, and this higher level of serum adiponectin is believed to protect hepatocytes. In patients with chronic hepatitis, serum adiponectin may be influenced by body composition parameters or by hepatic function.



To clarify this, we have measured the serum concentration of adiponectin in patients with chronic hepatitis caused by  infection with type C hepatitis virus, and compared this with body composition parameters. Fifty-two patients (mean age 56.3 +/- 9.6 yr, M/F = 29/23) with chronic type C hepatitis who underwent hepatic histomorphological study between January 2003 and October 2004 were included in the study. Before performing ultrasound-guided biopsy of the liver, blood samples were collected and the serum was separated. The serum concentration of adiponectin and hepatitis C virus was determinated by specific ELISA and quantitative RT-PCR assay, respectively. Histomorphological data were graded according to the hepatitis activity index (HAI) score and Knodel's score, as reported previously. The serum adiponectin concentration in the patients with chronic type C hepatitis was 9.1 +/- 5.5 mg/ml, which was not significantly different from that reported in normal individuals measured using the same assay system. Therefore, unlike the data already reported for patients with liver cirrhosis, the serum adiponectin level was not elevated in patients who retained their hepatic physiological function. In addition, there was no correlation between hepatic histopathological grade, hepatic function, and serum adiponectin level. On the other hand, it has been reported that healthy individuals show a strong correlation between body mass index(BMI) and serum adiponectin concentration.



Our observations suggested that the serum adiponectin concentration was affected by BMI(p=0.001), even among patients with chronic hepatitis C.



Abstract ID: W935


Impact Of Chronic Hepatitis C (HCV)infection and Comorbid Psychiatric Illness on Health-Related Quality Of Life in U.S. Veterans


J.K. Lim, R.C. Cheung, M. Goldstein, R. Cronkite



Chronic hepatitis C virus (HCV) infection has been shown to reduce health-related quality of life (HRQoL).  Multiple studies have demonstrated that U.S. veterans have a higher prevalence of psychiatric illness, and have a lower baseline HRQoL than the general population.  However, little data exists on HRQoL in U.S. veterans with chronic HCV infection, and the contributing role of comorbid psychiatric disease. AIMS: 1) To compare the HRQoL of U.S. veterans who are anti-HCV positive (HCV+) versus U.S. veterans who are anti-HCV negative (HCV-), and 2) Assess the prevalence and importance of comorbid psychiatric disease on HRQoL in these patients.



We identified 29,750 U.S. veterans who completed a veteran-specific HRQoL questionnaire (SF-36v) as part of the 1999 VA Large Health Survey, of whom 7709 patients participated within the Palo Alto VA Medical System.  Laboratory documentation of anti-HCV antibody status was determined in 864 patients.  Comorbid medical and psychiatric diagnoses were obtained from VA administrative files.  We compared HCV+ (n=201) and HCV- (n=663) patients along eight subscales and two summary scales of HRQoL, and prevalence of six psychiatric diagnoses using independent group t-tests.  Multiple regression analysis was then used to measure the association of anti-HCV+ status and psychiatric comorbidity in each SF-36v subscale and summary score. 



Patients who were HCV+ scored lower in HRQoL on four of eight SF-36v subscales (p<.01) and the mental component summary scale (p<.001) compared to HCV- patients.  These patients were significantly more likely to have depression (p=.01), post-traumatic stress disorder (PTSD) (p<0.004), and alcohol dependence (p<.001).  Multiple regression analysis demonstrated that depression and PTSD independently predicted lower HRQoL scores for all eight HRQoL subscales and both physical (p<.001) and mental component (P<.03) summary scales. 



Chronic HCV infection results in a significantly decreased HRQoL in U.S. veterans.  Depression and PTSD appears to contribute a significant additive HRQoL impairment in these patients.


Abstract ID: W1122


All Patients with Chronic Hepatitis C Over the Age of 50 Should Have Screening Colonoscopy Prior To Interferon Therapy


R. Koka, G. Mehta, V. Araya, K.D. Rothstein



The prevalence of polyps on screening colonoscopy has been well studied in patients with cirrhosis and as part of pre-transplant evaluation. Recent studies have indicated that there might be an increased prevalence in cirrhotics especially in the age group<50 with prevalence rates of up to 40%. There have been no studies examining the prevalence of polyps or colorectal cancer specifically in patients with chronic hepatitis C.



Our goal was to examine the prevalence of polyps in patients with chronic hepatitis C to determine if there was an increase compared to the average risk population.



Retrospective database review identified 181 screening colonoscopies performed in patients with chronic hepatitis C between 1998 & 2004. Histological data on the polyps removed were also examined.



181 screening colonoscopies were performed, 42 were excluded for repeat colonoscopy, rectal bleeding, or prior history of polyps. Of the 139 analyzed, 86 were men & 53 were women. 56/139 (40%) had polyps of which 24/139 (17%) had tubular adenomas. Other pathologies noted at colonoscopy included diverticulosis, AVMs and hemorrhoids. No cancers or dysplasia was recorded in this group of patients.


Men had 17/86 (19.7%) had tubular adenomas compared to women 7/53(13%). When subdivided by race, Caucasians (W) had higher rates of tubular adenomas 9/43(21%) compared to African Americans (AA) 12/82 (14.6%)





MEN (86)


    17 (19.7%)

WOMEN (53)


      7 (13%)

AA (82)


    12 (14.6%)



      9 (21%)



The prevalence of polyps in patients with chronic hepatitis C in our study is comparable to that of the asymptomatic average risk population (24-47%) though the mean age was lower than in prior studies (56 compared to 62.5). Since the incidence of polyps increases with advancing age, this study suggests that patients with chronic hepatitis C may have a higher prevalence of colonic polyps.


All patients with chronic hepatitis C over the age of 50 should be screened with colonoscopy prior to treatment given the significant prevalence of colon polyps, especially tubular adenomas.


Abstract ID: W915


National Survey Of Physician Knowledge and Attitudes Regarding Vaccination Against Hepatitis A and B in Patients With Chronic Liver Disease Due To Hepatitis C Virus Infection


S. Chaudhari, C.T. Tenner, E.H. Weinshel, E.J. Bini



Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. We evaluated physician knowledge and attitudes regarding vaccination against HAV/HBV in patients with chronic HCV infection.



A 2-page questionnaire was mailed to 3000 primary care (PC), 1000 gastroenterology (GI), and 1000 infectious diseases (ID) physicians randomly selected from the AMA Physician Masterfile. The survey was pre-tested prior to mailing and included questions about physician demographics, knowledge, and attitudes regarding vaccination. 



Among the 5000 physicians surveyed, 115 were undeliverable, 89 were not in practice, and 2038 (42.5%) of the 4796 eligible physicians returned completed surveys. There were no differences between respondents and non-respondents with regard to age, sex, geographic location, or specialty. Physicians knew that the following HCV+ persons should be vaccinated against HAV or HBV, respectively: normal ALT (66.4%, 69.0%), elevated ALT (73.5%, 75.8%), HCV PCR+ (77.4%, 79.6%), compensated cirrhosis (76.3%, 76.4%), decompensated cirrhosis (52.5%, 53.3%), and HIV+ (71.9%, 72.3%). More PC than GI or ID physicians stated that none of these HCV+ patients should be vaccinated against HAV (17.3% vs. 3.3% vs 5.1%, P <0.001) or HBV (15.8% vs. 3.0% vs. 4.6%, P <0.001). Responders agreed/strongly agreed that HCV+ patients should be tested for HAV antibodies (73.2%), susceptible patients should be vaccinated against HAV (83.2%), HAV antibody testing should be done prior to HAV vaccination (58.1%), and that the HAV vaccine is safe (79.6%) and effective (72.0%). In addition, physicians agreed/strongly agreed that HCV+ patients should be tested for HBV antibodies (84.2%), susceptible patients should be vaccinated against HBV (87.2%), HBV antibody testing should be done prior to HBV vaccination (74.1%), and that the HBV vaccine is safe (82.3%) and effective (78.3%). The proportion of PC physicians who agreed with these statements regarding HAV/HBV vaccination were all significantly lower (P <0.001) as compared with GI or ID physicians.   



Among physicians in the U.S., there are substantial gaps in knowledge about HAV and HBV vaccination of patients with chronic HCV infection and this varies significantly among specialties. HAV and HBV vaccine education programs are needed.


Abstract ID: W922


Outcome Of Hepatitis C Treatment in a Government-Sponsored Clinic for An Underserved Population


J. Iturrino, C.J. Sanchez, V. Velazquez, D. Iturrino, A. Ortiz, P. Costas, E.A. Torres



One half of the population of Puerto Rico is insured under government-sponsored managed care. Of this population, 3,576 tested positive for Hepatitis C (HCV)ab between 2001 and 2002. Treatment for HCV is not covered.  In an effort to address this problem, the Department of Health and the University of Puerto Rico established a pilot clinic for evaluation and treatment of patients with chronic hepatitis C without health coverage. The program included medical evaluation and follow-up, genotype and viral load, pertinent laboratories, and treatment with pegylated interferon plus ribavirin. The aim of this study was to determine the outcome of patients referred to the clinic.



Records were reviewed for demographic characteristics, medical information, treatment decision, compliance with therapy, side effects, completion of treatment and reasons for discontinuation.

Results: Of 405 referred patients, 308 were seen at least once; 153 (49.7%) did not receive treatment. Reasons for not receiving treatment included: 99 (64.7%) were lost to follow up after the initial evaluation; treatment was contraindicated in 32 (20.9%); treatment was not indicated in 13 (8.5%); 5 (3.3%) patients refused treatment and 4 (2.6%) never started due to social problems. The other 155 (50.3%) patients started treatment. In 41 (26.5%), treatment was discontinued for the following reasons: 22 (53.7%) were non responders; 13 (31.7%) had adverse effects; 4 (9.8%) developed co-morbidities during treatment; and 2 (4.9%) had unrelated deaths. Another 36 patients (23.2%) were lost to follow up after having started treatment. Fifty-four (34.8%) completed treatment and 24 (15.5%) are currently in treatment. Of the original 308 patients, only 78 (25.3%) have the potential of a full therapy and a response.



The pilot clinic for uninsured HCV patients did not fulfill the aims of the program. Access to treatment for hepatitis C is not enough for achieving success. Resources are needed to improve identification of suitable candidates, compliance and management of side effects. Investing in patient and primary physician education, clinic coordinators, psychiatric consultants, and non-covered medications for side effects should improve the success of therapy and result in a more efficient and cost-effective use of limited government funds.