The AUC's for the separation of mild/moderate from advanced ﬁbrosis were 0.810 and 0.798 for the FIB-4 and APRI respectively.Using cut-oﬀs of 0.85 and 1.80, the FIB-4 predicted 127 of 146 for mild/moderate ﬁbrosis (NPV=87%) and 28 of 36 for advanced ﬁbrosis (NPV= 77.8%). The indeterminate zone was 88 patients (32.6%). Using cut-oﬀs of 0.75 and 2.05, the APRI predicted 114 of 127 (NPV=89.8%) for mild/moderate ﬁbrosis and 29 of 42 (PPV= 69%) for advanced ﬁbosis. The indeterminate zone was 101 patients (37.4%). Conclusion: The FIB-4 and the APRI are equal in their abilitiy to separate mild from signiﬁcant ﬁbrosis, and mild/moderate ﬁbrosis from advanced ﬁbrosis simce they have near identical predictive values, AUC's, and indeterminate zones.While both are good at separating mild and signiﬁcant ﬁbrosis, and negatively predicting advanced ﬁbrosis, neither is very accurate in the positive predictive of advanced ﬁbrosis. FIB-4= Age(years) x AST (U/L)/ Platelets (10 9 /L)xALT(U/ L) 1/2 APRI= AST/ULN x 100 / Platelets (10 9 //L) S2079 The Impact of Hepatitis B (HBV), Hepatitis C (HCV) and Non-Alcoholic Fatty Liver Disease (NAFLD) Guidelines On Clinical Practices Jillian Kallman, AimalArsalla, Angela M. Wheeler, Ruben D. Aquino,Kathy L.Terra, Rebekah Euliano, Zobair M. Younossi Although guidelines for HBV and HCV and position statements for NAFLD have been put forth by diﬀerent societies, awareness of these guidelines and their impact on the physician practices have not been measured. Aim: To assess the attitudes of primary care physicians (PCP), gastroenterologists (GE), and hepatologists (HEP) regarding HBV, HCV and NAFLD. Design: An in-depth questionnaire was sent to PCP, GE, and HEP, assessing their familiarity with issues related to HBV, HCV and NAFLD. The survey contained 29 NAFLD items, 35 HBV items, and 35 HCV items. Comparisons were made between diﬀerent practice specialties, using one-way ANOVA with Bonferroni adjustments. Results: A totalof 161 surveys have been received (101 PCP, 30 GE,26 HEP).Demographics of survey respondents included age (46.9 years +/- 12.4), gender (Male = 59.9%), practice environment (42.8% Urban, 46.6% Suburban, 3.3% Rural, 7.3% multiple environments), with a median of 60 patients seen per week. The majority of PCP, GE, and HEP agreed on most screening issues related to HBV,HCV and NAFLD.However, some important diﬀerences exist. PCP considered HCV to be less common than both GE (p=.0001) and HEP (.001) and NAFLD more common than HEP (.0001). Over 40% of PCP reported being unaware of any oﬃcial guidelines for HBV, HCV or NAFLD, compared to 13% of GE and 4% of HEP. A majority of HEP (88%) and 40% of GE were familiar with and followed AASLD guidelines. PCPs were most likely to be familiar with and use USPSTF guidelines (24%) followed by AAFP (15%), ACP (14%) and AASLD guidelines (5%). NeitherHEP norGE reported following AAFP guidelines. Further, PCP rated themselves signiﬁcantly less knowledgeable of HBV guidelines than both GE and HEP (p=.003 and p=.0001, respectively) as well as for HCV guidelines (p=.0001 each). PCP also reported signiﬁcantly less reliance on guidelines when making a decision to screen for HBV and HCV (P<0.05). Although PCP, GE and HEP did not diﬀer in rating the eﬀectiveness of HCV treatment, HEP rated the eﬀectiveness of HBV treatment higher than PCPs (p=.0001) and PCPs rated the eﬀectiveness of treatment for NAFLD higher than HEP (p=.0001). Furthermore, side eﬀects of HBV and NAFLD treatment were rated as more harmful by PCP than HEP (p=.001) or GE (p=.009). Conclusions: Although practice guidelines for three common liver diseases exist, there continues to be a lack of familiarities and practice variation in clinical practice. As expected, specialists are more aware about these guidelines than primary care physicians. In order to increase knowledge base about important liver diseases, eﬀorts should be focused on primary care practices. S2080 Outcome of Pediatric Autoimmune Hepatitis Maria Triantafyllopoulou, Karan McBride Emerick, Hector Melin-Aldana, Peter F. Whitington Background: Since the early 1970s AIH has been thought to require life-long immunosuppres- sion. Evidence of bile duct injury on liver biopsy has been associated with decreased response rate to treatment. Aim: To examine whether AIH patients can regain tolerance and identify predictors for such outcome. Study Design: We reviewed the medical records of 45 children with histologically proven AIH, 31 ANA/SMA positive, 3 LKM-1 antibody positive, 6 patients who were antibody negative and 5 with not known antibodies but with clinical criteria for AIH. The median follow-up was 5 years (range 0.8-14.3 years). We excluded patients who presented in liver failure and with positive AMA or biopsy consistent with PSC.Results: Five patients required long-term immunosuppression for other coexistent autoimmune dis- ease. Four patients had cirrhosis without any inﬂammation and did not receive immunosuppr- ession. Ten patients were lost to follow-up or transitioned to adult care. Complete immunos- uppression was stopped successfully in 23% of the remaining patients (6 out of 26) over 5.3±4.2 years. Fifty eight percent of patients (16 out of 26) were successfully weaned oﬀ steroids over 3.6±4.2 years. Of the eleven patients not able to be weaned oﬀ of steroids, two had bile duct injury on presentation and half had active cirrhosis. None of the patients who regained tolerance had either cirrhosis or bile duct injury on presentation. Conclusion: About two in three patients with AIH can be weaned oﬀ steroids and one in four patients regain liver tolerance and can be weaned oﬀ all medications. Extensive ﬁbrosis and bile duct injury may predict outcome in therapy. S2081 Peginterferon and Ribavirin for Treatment of Hepatitis C and HIV Co- Infection: A Meta-Analysis of Randomized Controlled Trials Ajitinder S. Grewal, Abhishek Choudhary, Matthew L. Bechtold, Srinivas R. Puli, Mohamed O. Othman, Praveen K. Roy Background and Purpose: Hepatitis C (HCV) co-infection is a signiﬁcant contributor of morbidity and mortality among HIV patients. The progression of liver disease is accelerated in these patients. Combined treatment with peginterferon (PEG) and ribavirin (RBV) is the A-311 AGA Abstracts standard treatment for HCV mono-infected patients. Recently, several studies have repo the eﬃcacy and adverse eﬀects of treating the HIV/HCV co-infected patients with peginte feron and ribavirin. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the eﬃcacy and side eﬀects of peginterferon and ribavirin versus standard interferon (INF) and ribavirin. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conf proceedings were searched (through 10/07). RCTs enrolling adult subjects and comparin PEG/RBV with INF/RBV were included. Studies were assigned a quality score using Jadad score.Standard forms were used to extract data by two independent reviewers. Pooled estimates of the following outcomes were obtained: End of treatment response (ETR), sustained viral response (SVR), and side eﬀects. Separate analyses were performed for e outcome by using odds ratio (OR). Publication bias was assessed. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency and if noted,a random eﬀectsmodelwasperformed. Results: Five trialssatisﬁed the inclusion criteria (1,335 patients). The mean age ranged from 37-45 years. 86.2% of patients were on HAART the Two trials used PEG alpha-2a (180 mcg per week) & 3 trials used PEG alpha-2b (2 trials used 1.5 mcg/kg/week & 1 trial used 100-150 mcg/week). Dose of RBV was 800-1,200 m daily. PEG/RBV achieved a higher SVR compared to INF/RBV (OR 2.94, 95% CI: 1.70-5.08 NNT 5). ETR was also higher with the PEG/RBV (OR 3.17, 95% CI:1.93-5.17, NNT 5). SVR was signiﬁcantly higher with PEG/RBV, regardless of the genotype. The side eﬀects proﬁle was similar among the treatment groups (OR 1.04, 95% CI:0.82-1.32, p=0.73). However, inﬂuenza-like symptoms were more common in the INF/RBV group (OR 1.68, 95% CI:1.06-2.60, NNH 12). No signiﬁcant publication bias was present. Conclusion: Peginterferon and ribavirin achieves a higher SVR compared to standard interferon and ribavirin therapy in HCV/HIV co-infected patients (NNT=5). Inﬂuenza-like symptoms were more common in patients treated with standard interferon and ribavirin. However, other side eﬀects were similar in the two treatment groups. S2082 Viral Kinetics During Adefovir in Treatment NaÏVe Chronic Hepatitis B (CH Patients Hissar Syed, Eva Herrmann, ManojKumar,MeiFang Ong, Shiv Kumar Sarin Background and Aim: Mathematical analysis of viral kinetics is helpful in predicting treat response and long-term outcome of antiviral therapy. However, limited data is available HBV kinetics during adefovir treatment in HBeAg negative and positive CHB patients trea with adefovir. Patients and Methods: Thirty-one naïve CHB patients received adefovir 10 mg/daily and frequent blood sampling was done. Viraldecay during the ﬁrst 4 weeks of therapy was described by a biphasic model to determine the eﬀectiveness of blocking vi production ( ε) and the loss of infected cells ( δ). HBV DNA was measured with hybrid capture assay (lower detection limit 4,700 copies/ml). Liver histology was studied for hist icalactivity index (HAI) and ﬁbrosis. Results: Patients were divided into Gr 1: HBeAg negative (n=12, mean age: 41.7 +/- 12.5yr, 83% M) and Gr 2: HBeAg positive (n=19, me age:37.9 +/- 14.5yr, 95% M).The mean +/- SD [median(range)] baseline HBV DNA 7.52 +/- 1.22 [7.46(5.55-8.99)] and 7.87 +/- 1.21 [8.11(5.16-9.23)] log copies/ml respectively (P>0.2), ALT 114 +/- 92 [82(36-381)] and 149 +/- 100 [109(53-417)] IU/L respectively (P>0.2), HAI 6.3 +/- 2.1 [7(3-9)] and 5.4 +/- 1.6 [5(3-8)] respectively (P>0.2) and ﬁbrosis 2.8 +/- 1.5 [3.4(1-4)] and 1.8 +/- 1.1 [2(0.0-4.0] respectively (P=0.20), were comparable in both groups. The median (range) of viral kinetic parameters were: ε =83% (0-97%) and 78% (0->99.5%) in Gr 1 and Gr 2 respectively (P>0.2), log decay during ﬁrst phase of vir kinetics 0.77 (0.00-1.52) and 0.66 (0.00-4.90) respectively (P>0.2) and δ =0.10 (0.00-1.4)/ day and 0.01 (0.00-1.76)/day respectively (P=0.1). Correlation between δ with age in the patients as whole (r=0.42, P=0.02), and in HBeAg negative patients was seen (r=0.83, P= 0.001), but not in HBeAg positive patients (r=-0.15, P>0.2). No association was found wit other baseline parameters. Signiﬁcant negative correlation at day 28 was seen between DNA and HAI (r=-0.73, P=0.02) and a trend for negative correlation between HBV DNA and ﬁbrosis score (r=-0.55, P=0.10) in HBeAg positive but not in HBeAg negative patient Conclusions: (i) Adefovir treatment results in similar decline in HBV DNA levels in HBeAg negative and positive patients. (ii) Surprisingly, older patients with advanced liver injury show a more rapid viral reduction. (iii) Baseline ALT levels do not inﬂuence viral reductio S2083 Outcome of HCV Therapy in Patients with Schizophrenia and/or Bipolar Disorder Fatma Barakat, Deanna Oliver, Lita Petcharaporn, Meghan Carlson, Lisa Richards, Ed Barber, Elliot Alpert, Khaled Selim, William Perry, Tarek Hassanein HCV is known to infect more than 4 million individuals in the US. A signiﬁcant number of HCV infected individuals have an underlying psychiatric illness particularly Anxiety, Depression, Bipolar Disorder or Schizophrenia. Interferon based therapy is known to exac bate any underlying neuropsychological disorders. Accordingly patients (pts) with a pre- existing psychiatric illness are excluded from HCV treatment. The aim of our study was t explore the possibility of treating HCV infected pts with Bipolar Disorder or Schizophrenia with Interferon (IFN) based therapy. Methods: Between 2000 and 2006, 2035 pts with HC were seen in the liver clinic. Of which,705 (34.6%) had an underlying psychiatric illness with 190 pts having Bipolar Disorder or Schizophrenia. All pts were evaluated for IFN bas therapy. Of the 705 pts, 219 (31%) began treatment with IFN based therapy. The subject of this analysis are 43 pts with Bipolar Disorder or Schizophrenia who began IFN based therapy. All pts were followed by a psychologist/psychiatrist and were stable on psychotr medications before starting IFN therapy. Results: The mean age was 49±7.4 years; 60.5% were male; 72.1% Caucasian, 16.3% African American and 11.6% other. 75.6% were genotype 1 and 24.4% genotype 2, 3 or 4. 46.7% had mild to moderate ﬁbrosis. 30 (69.8 pts had Bipolar Disorder (Group A) and 13 (30.2%) had Schizophrenia (Group B). There was no signiﬁcant diﬀerence between the 2 groups in demographics, genotype, disease severity, baseline ALT, AST, platelet count, and HCV viral load. However, signiﬁcantly mo Bipolar Disorder pts were female (p=0.033). 60.5% successfully reached end of treatment. 9 pts in Group A vs. 3 in Group B discontinued treatment early due to exacerbation of AGA Abstracts