Repeated spontaneous clearance of hepatitis C virus infection in the setting of long-term non-progression of HIV infection

Hepatitis C Virus (HCV) and human immunodeficiency virus (HIV) are global pandemics that affect 170 million and 35 million individuals, respectively. Up to 45% of individuals infected with HCV clear their infections spontaneously – correlating to factors like aboriginal descent and some host specific immune factors. HIV, however, establishes true latency in infected cells and cannot be cured. In the setting of longterm non-progressors (LTNPs) of HIV, a state of immune preservation and low circulating viral load is established. Regarding HIV/HCV co-infection, little is known about the relationship between spontaneous clearance of HCV infection and long-term control of HIV infection without medical intervention. We describe a case of a HIVinfected female defined as a LTNP in whom spontaneous clearance of HCV was documented on multiple occasions. Similar cases should be documented and identified in an effort to develop novel hypotheses about the natural control of these infections and inform research on immune-based interventions to control them

Impact of population center (PC) size on access to care in advanced hepatocellular carcinoma (HCC).

489 Background: To evaluate access to subspecialists, local therapies, treatment at a specialized HCC center, and survival in advanced HCC patients (pts) based on geographical distribution. Methods: Retrospective chart review was performed on HCC pts who received sorafenib in British Columbia from 2008 to 2016. Pts were stratified by Statistics Canada PC size criteria: large urban PC (LUPC), medium urban PC (MUPC), and small urban PC (SUPC). Chi-square tests and Kaplan Meier were used to analyze the groups. Results: Of 288 pts, geographical distribution was: LUPC 75%, MUPC 16%, SUPC 8%, and rural 0.3%. Age, gender, and ECOG performance status were similar; a higher proportion of Asians (50 vs 9 vs 4%), Child Pugh A (93 vs 83 vs 83%), and hepatitis B (37 vs 15 vs 4%) was observed in LUPC vs MUPC and SUPC, respectively. SUPC pts were less likely to see a hepatologist (p=0.04, Table); access to other subspecialists was similar. Pts from LUPC were more likely to have transarterial chemoembolization compared to MUPC and SUPC (38 vs 20 vs 21%; p=0.04); receipt of other local therapies was similar. Sixty percent were treated at a specialized HCC center and were more likely to see a hepatologist (83 vs 19%), hepatobiliary surgeon (57 vs 42%), and/or interventional radiologist (32 vs 13%) (all p&lt;0.01). Median OS was higher for pts treated at a HCC center (24.7 vs 13.2 mo, p&lt;0.01), but similar when stratified by PC size (overall mOS 19.3 mo, p=0.59). Conclusions: Geography did not significantly impact access to care or survival, but pts treated at a specialized HCC center have improved survival. Further research is needed to better understand social and clinical factors that influence these findings. [Table: see text] </jats:p

The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study

Background: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. Results: Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; p < 0.001), Child–Pugh A (94% vs. 83% vs. 80%; p = 0.022), and hepatitis B (37% vs. 15% vs. 4%; p < 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; p = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; p = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; p < 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503–0.844; p = 0.001). Conclusions: Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival.Medicine, Faculty ofAlumniNon UBCMedical Oncology, Division ofMedicine, Department ofReviewedFacultyResearche

The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study

Background: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. Results: Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; p &lt; 0.001), Child–Pugh A (94% vs. 83% vs. 80%; p = 0.022), and hepatitis B (37% vs. 15% vs. 4%; p &lt; 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; p = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; p = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; p &lt; 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503–0.844; p = 0.001). Conclusions: Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival.</jats:p

The impact of geography and center volume on access to care and outcomes in advanced hepatocellular carcinoma (HCC): A retrospective population based study.

e15597 Background: Treatment of advanced HCC is complex and involves specialized multidisciplinary care. We aimed to characterize the impact of geography and center volume on access to care and outcomes in HCC patients (pts). Methods: HCC pts who received sorafenib in British Columbia from 2008 to 2016 were included. Pts were stratified by rural vs urban status (distance from cancer center), and high volume (HVC) vs lower volume (LVC) centers. Chi-square tests and Kaplan Meier were used to test for differences between groups. Results: Of 288 pts identified, median was age 62 (IQR 56-72), 81% male, 40% Asian, 82% ECOG 0/1 and 90% Child Pugh A. Hepatitis C (32%), hepatitis B (31%) and alcohol (25%) related liver disease were most common. Most pts resided within 100 km (85%) and 173 (60%) were treated at HVC. Ethnicity, liver disease etiology, ECOG and M1 disease varied by stratification (Table). Rural pts were more likely to see an internist (30% vs 16%, p=0.04); access to other subspecialists was similar (all p&gt;0.05). HVC pts were more likely to see a hepatologist (83% vs 19%), hepatobiliary surgeon (57% vs 42%), and/or interventional radiologist (32% vs 13%) compared to LVC pts (all p&lt;0.01). Number of specialists seen correlated with survival (36.4 vs 20.3 vs 12.6 mo for ≥ 3 vs 2 vs 1 specialist(s), p&lt;0.01). Median OS from time of diagnosis was higher for HVC pts (24.7 vs 13.2 mo, p&lt;0.01), but similar when stratified by distance (p=0.44) and from sorafenib initiation (p=0.66). Conclusions: HCC patients treated at a HVC are more likely to see specialized clinicians and have improved survival outcomes. Further research is needed to understand social and clinical factors that influence these findings. [Table: see text] </jats:p