AASLD Abstracts Figure 1: ROC curve for two models predicting the development of cirrhosis within 1 year in patients with chronic HCV infection Tu1483 PREVALENCE, MORTALITY AND HEALTH CARE UTILIZATION OF HEPATITS C INFECTION (HCV) AMONG MEDICARE BENIFICIARIES RECEIVING CHRONIC HEMODIALYSIS (HD) Rati Deshpande, Maria Stepanova, Pegah Golabi, Chapy Venkatesan, Kimberly Brown, Zobair M. Younossi Background: Global prevalence of HCV among chronic HD recipients is around 9.5% (Goodkin DA, 2013). Given this high prevalence, HCV screening of HD subjects is routinely recommended. Additionally, recently approved anti-HCV regimens have high efficacy and good safety in HD recipients. Since HD subjects qualify for Medicare coverage, data on the prevalence and outcomes of HCV in these patients will be important. Aim: Assess the prevalence, resource utilization and mortality amongst Medicare beneficiaries with HCV receiving chronic HD. Methods: We used Medicare database (2005-2016) to assess the prevalence and outcomes of HCV in chronic HD recipients by using ICD-9&10 codes. Mortality was assessed by Medicare-linked death registry while healthcare utilization included episodes of care, length of stay, total charges/payments. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. Results: Of 15.5 million Medicare recipients (5% sample of 12-year datasets), 291,663 subjects were receiving chronic HD (67.3±15.2 years, 55% male, 55% white, 49% age-based Medicare eligibility). Prevalence of HCV in Medicare subjects on HD was 4.2% which was higher than in Medicare subjects not on HD (0.78%) (p=<0.0001). These prevalence trends remained stable over the study period (Figure). As expected, HCV patients on HD were more commonly cirrhotic (31.6% vs. 5.7%, p<0.0001). In multivariate survival analysis, in addition to age [OR: 1.053 (95% CI=1.053-1.054)], being male [1.067 (1.048-1.086) and having cirrhosis (3.4 (3.3- 3.6) (all p<0.0001) were independent predictors of 1-year mortality. The mean total inpatient payment for HCV patients on HD remained stable after adjustment for inflation [2005 ($73,803) to 2016 ($72,133), p=0.54 for a trend] but was higher (p<0.0001) than HD patients without HCV [2005 ($56,336) to 2016 ($55,057), p=0.63 for a trend]. The outpatient total payment for HD patients with HCV decreased from 2005 ($53,497) to 2016 ($35,439, trend p=0.0013) while remaining significantly higher than HD patients without HCV [(2005) $45,561 to (2016) $30,794, trend p=0.0049]. In generalized linear regression analysis, after adjustment for age, gender, race, and location; HCV and cirrhosis were contributors of greater inpatient [relative increase +22.1% (+19.2 to +25.0%)] and [+59.7% (+56.9% to +62.6%)] and outpatient [+18.4% (+14.6% to +22.2%)] and cirrhosis [+9.4% (+6.2% to +12.6%)] spending. Conclusions: Medicare HD recipients have higher mortality and resource utilization. Although HCV prevalence in Medicare HD recipients is high, these rates are lower than those reported in the literature, suggesting potential under screening for HCV. Given the importance of identifying HCV and availability of effective treatment, universal screening HD programs and linkage to appropriate HCV care must be implemented. Tu1484 HEPATITIS C SCREENING IN THE COLONOSCOPY SUITE: PATIENTS ARE THERE, WHY DON’T WE SCREEN THEM? Ahmad Abu-Heija, Bashar Mohamad, Maher Tama, Pradeep R. Kathi, Mohammed Mustafa Nayeem, Mowyad Khalid, Zaid Kaloti, Raya Kutaimy, Paul H. Naylor, Murray N. Ehrinpreis, Milton G. Mutchnick Background: HCV screening for individuals born between 1945 and 1965 (baby boomers) is recommended by the US Centers for Disease Control due to the fact that more than 70% of positive patients are in that cohort. Since baby boomers constitute a large proportion of patients undergoing screening colonoscopy, our objective was to evaluate whether colonos- copy suite screening of a predominantly AA urban population has the potential to identify unaware infected patients, who can potentially be treated with DAA therapy. Methods: We retrospectively analyzed our endoscopy database for patients undergoing screening colonoscopy, born between 1945 and 1958, and who had a colonoscopy in 2014 or 2017. We determined whether patients were previously tested for HCV with an enzyme immunoassay (EIA) detecting antibodies to HCV and subsequently confirmed by HCV PCR. Results: A total of 988 patients underwent screening colonoscopy, 444 in 2014 and 544 in S-1338 AASLD Abstracts 2017. Patients’ demographics were similar in both groups from 2014 and 2017, being predominantly AA, 71.4% and 79%, respectively. Females comprised 53.4% and 54.4% of the participants, respectively (p=0.746). Mean age (± SD) was 69.1 (±2.2) and 64.9 (±3.6) years, respectively. Evidence of prior testing for HCV was better in 2017, 40.3% (219/544), than in 2014, 31.5% (140/444) (p=0.005). Testing rates were similar for both genders in 2014 and 2017 and race had no impact on testing rates in both groups of patients. Antibody positivity rate for patients who had been tested was 42.9% (60/140) in 2014 and 31.5% (69/219) in 2017. The rate of antibody positivity was higher in AA than non-AA patients in 2014 (52/107=48.6% vs 8/33=24.2%, c 2 p=0.013) as compared to 2017 (54/169=32.0% vs 15/50=30.0%, c 2 p=0.794). Furthermore, of EIA positive patients, a viral load was detected using PCR in 2014 and 2017, in 95.0% and 96.5% of patients, respectively. Conclusion: Incorporating point of care hepatitis C screening in open access urban colonoscopy suites, accessed largely by AA, can prove valuable in identifying a significant number of yet untreated, infected individuals. Our hypothesis is that such a model can be conveniently introduced as an additional venue for HCV screening, yielding significant positive outcomes to the public’s health. Tu1485 RACIAL/ETHNIC DISPARITIES IN THE HEPATITIS C VIRUS CASCADE OF CARE PERSIST IN THE ERA OF DIRECT ACTING ANTIVIRALS: AN URBAN SAFETY-NET HOSPITAL EXPERIENCE Dina Ginzberg, Chantal Gomes, Benny Liu, Taft Bhuket, Robert J. Wong Background: Despite the availability of highly effective and well-tolerated therapies for hepatitis C virus (HCV), delays and gaps in the HCV care cascade contribute to disease progression to cirrhosis and cirrhosis-related complications, and this remains a major barrier to HCV eradication. These delays and gaps in the HCV care cascade are particularly concerning among vulnerable, safety-net populations. We aim to evaluate disparities in the HCV care cascade among an urban, ethnically diverse, safety-net system, focusing on race/ethnicity- specific disparities. Methods: We retrospectively evaluated adults with chronic HCV among a single-centered safety-net health system from 2002 to 2018. HCV care cascade was assessed by following patients from time of diagnosis (confirmed with HCV RNA) to first HCV clinic visit (linkage to care), treatment initiation, and sustained virologic response (SVR) assessment. Overall rates of linkage to care, treatment, and SVR12 were compared with chi-square testing, and median time between stages of the care cascade were compared with Student’s t-test or analysis of variance. Results: Among 600 HCV patients (60.7% male, mean age 53.9 years, 92.5% treatment naive) 20.7% were non-Hispanic white (NHW), 49.2% African Americans, and 30.2% Other (i.e Asian/Pacific Islander, Native American, Hispanic or Unknown). Overall, 65.0% had Medicaid or indigent care insurance, 5.9 % were homeless, 5.6% had active alcohol use, and 55.6% had history of IVDU. Overall linkage to care was achieved in 86.2% (median time, 146 days, IQR 30 – 780), treatment initiation in 72.6% (median time linkage to care to treatment, 221 days, IQR 109 – 840), and SVR12 achieved in 89% of those treated. Compared to NHW, while overall linkage to care within one year of HCV diagnosis demonstrated a lower trend in African Americans (53.9% vs. 64.9%, p= 0.08), retention to care (successful completion of subsequent HCV clinic visit after initial linkage) was similar by race/ethnicity (86.4% in African Americans vs. 89.0% in NHW, p= 0.46). Among HCV patients linked to care, receipt of HCV treatment was significantly lower in African Americans compared to NHW (70.4% vs. 74.8%, p<0.04), whereas SVR12 was similar among those that were successfully treated (96.0% vs. 97.4% in NHW, p=0.40). When evaluating median time progressing through the HCV care cascade, significantly longer delays from linkage to care to receipt of treatment was observed in African Americans (280 days vs. 165 days, p<0.05) and other race/ethnicity (322 days vs. 165 days, p<0.05) compared to NHW (Figure). Conclusions: Among an urban safety-net hospital population, significant race/ethnicity-specific disparities in HCV care cascade were observed. Despite similar rates of SVR12, ethnic minorities experienced significant delays in receipt of treatment even after successful linkage to care. Tu1486 THE EXISTENCE OF EXTRAHEPATIC MANIFESTATIONS IN CHRONIC HEPATITIS C VIRUS INFECTION INCREASE HEPATOCELLULAR CARCINOMA RISK: A NATIONWIDE POPULATION-BASED COHORT STUDY Chun-Hsiang Wang, Shih-Fang Ou, Yuan-Tsung Tseng Background: Epidemiologic evidence clearly indicates a close relationship between chronic hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) risk. In addition, HCV infection also is frequently reported to complicate extrahepatic manifestations (EHMs). However, it has been almost unknown about whether EHMs are potential effect modifiers on HCC development. We designed a nationwide large-scale long-term study using registry data to comparatively analyze HCC risk of treatment-naïve HCV patients with EHMs versus