M1421 Histopathological Features of Liver Biopsy in Sickle Cell Patients with Iron Overload and Hepatitis C Mohamed Haxsan, Syed Hasan, Samael Giday, Mamoon Elbedawi, Tammy Naab, Osvealdo Castro, Duane Smoot, Alpha Banks Objective: To evaluate the effects of HCV mfectinn on hepatic pathology m sickle cell patients with Iron overload. Patients and Methods: Between 1992 and 2002, twenty of 44 sickle cell patients with territni level more than 1000 ng/dl agreed to have hver biopsy at Howard University Hospital (50% men, 50% women, median age 37 years). All the patients had multiple transfusmns in the past (more than 40 units) The majority of the patients (90%) had Hemoglobin SS and 10% had Hemoglobin SC. None of the patients had iron chelation therapy prior to biopsy. Liver biopsy results and clinical reem'ds were retrospectively reviewed. A blinded pathologist performed the histopathologic assessments of liver biopsies. Histology including hepatic iron content was graded. Results: Hemosidemsis was present in all of the biopsy' specimens. Fourteen (70%) had 4+ iron depositions in bepatocyles, one patient had 3 +, one patient had 2 + and three patients had only 1 + hepatic iron deposition. One patient had pigment granules in hepatocytes but no iron stain was performed. Advanced cirrhosis was noted in three patients, recipient cirrhosis in one patient and bridging fibrosis in three patients Patchy sinusoidal fibrosis was obser`,'ed in eight patients. All the patients with advanced and incipient cirrhoses had anti HCV antibodies, whereas only two patients with patchy sinusoidal fibrosis were HCV positive. Only one patient with HCV infection had no evidence of fibrosis All patients with HCV refection had 4 + hepatic iron whereas only 61% of patmnts without HCV refection had 4 + -iron deposition, considering that all received simi 'lar number of transfusions. Conclusion: Our data indicates that patients with sickle cell disease who have hepatitis C virus infection are at an increased risk of developing severe hepatic iron overload and advanced cirrhosis. M1422 Increased Prevalence of Type 2 Diabetes Mellitus among Hispanic Patients with Chronic Hepatitis C Virus Infection Marina Torres, Betty"Chinea, Santa M.efle, Federico Rodriguez-Perez, Doris H. Toro BACKGROUND: The prevalence of type-2 diabetes mellitns (DM) m Puerto Rico (PRY, as reported in 1999, is 967%. This prevalence is superior to that observed in the United States (5.6%). An assc.ciation between DM and chronic hepatitis C virus (HCV) inlection has been recognized, although the biologmal mechanisms of this association remain unknown. 1"he purpose of this stud}' is to examine the prevalence of DM in a representative sample ot Hispanic patients with cl'Lronic HCV infection evaluated at the San Juan VA Medical Center and correlate the presence of DM with age and body mass index (BMI). METHODS: The medical records of patients randomly" selected from the hospital HCV registry, which ccmsisted of 1577 patients diagnosed between 1992-2002, were reviewed, Patient's age, sex, BM1, laboratory data and the presence of a diagnosis of DM were recorded. The diagnosis of DM was determined using the American Diabetes Association gnidelmes based on lasting plasma glucose measurement (> 126 mg/dl) and the patient's medication histury. Presence of HCV infection was assessed by the presence of serum HCV-specific antibodies (anti-HCV). The BMI of each patient was classified according to the National Heart/Lung and Blood Institute as: lean (< 25 kg/m2), overweight (25- 29.9 kg/m2), obese (30-349 kg/m2) or morbidly obese (>35 kg/m2). RESULTS: A total of 735 records .,,,.ere reviewed. 99.3%(730) of the patients were male and 07% (5) temale, The mean age was 54.3 (range: 29-92). The BMI distribution of the patients was: 35.6 % kan, 39.3% overweight, 182% obese and 68% morbidly obese with a mean of 27. I kg/m2 235(32%) of the 735 patients had DM, of which 33,6% (79) were lean, 36.6% (86) overweight, 20.9% (49) obese and 8.9% (21) morbidly obese. When stratihed into < 30 kg/m2 or >30 kg/m2 the proportion of patients with DM was higher in those obese and morbidly obese when compared to lean and over'eight patients (p< 0.05). The presence of DM increased with patient's age, with higher prevalence in patients older than 50 years (p<O.O1). The prevalence of DM in our patients diftered from that of the gclmral population (P<0.01). CONCLUSIONS: The overall prevalence of DM m our hepatitis C patients is three times more frequent than that reported for the general population in PR (32% vs 9.7%) Furthermore; this prevalence is higher than previously reported on populations with HCV infection in the USA (21%), The presence of DM ni our population appears to increase alter 50 years of age and with BM1 above 30 kg/m2. M1423 Steatosis in Hepatitis C Genotype 3 is associated with Intravenous Drug Abuse and not with Fibrosis Pratima Sharma, Hector Rodnguez-Luna, Marianne Rosati, Jose Hernandez, Vijayan Balan, James Wilhatns, Thomas Byre, Hngn E. Vargas, Da`,,id Douglas, M. EdsWn Harrison, Monte E Anderson, Tomasz Laskus, Jorge Rakela Hepatic steatosis is a recognized histological feature of chronic hepatitis C (CHC). pamcularly in genotype 3 Other contributing factors for hepatic stearosis include obesity, alcoholism, hypertriglyceridemia and diabetes mellitns. However, the demographics and associations of hepatic steatnsis in CHC are not well known. AIM To determine 1) association bet`,veen degree of steatosis and HCV genotype, 2) correlation of steatosis with fibrosis, body mass index (BMI), s~:mm cholesterol and triglycerides (TG), 3)association between steatosis and the mode of transmission among the patients with genot},?e 3 Methods 295 consecutive hepatitis C patients (genotype 1, n = 218, genotype 2, n = 43, genotype 3, n = 32) at our restitution were studied. Demographic information (age, gender, height, Weight, geno- type, ask tactors, serum cholesterol and TG) and biopsy results were collected Steatosis was graded based on % ot afli~cted hepatocytes: grade 0 (0-2%), grade 1 (3-29%), grade 2 (30-59%), grade 3 (> 60%). Results The average age tbr genotype 3 vs. non genotype 3 patmnts was 45.1 +/- 6.6 years vs 50.1+/- 9.3 }'ears, (p<0.04), The moderate to severe steatosis (grade 2,3) was more pronounced in HCV genotype 3 (genntype 3 = 50% vs genotype 1 = 173% and genotype 2 = 2.4% ; p<0.001). There was no significant correlation between the grades of steatosis and fibrosis score, BM1 and TG levels [or all the patients and tbr the mdi`,idual genotypes The moderate to severe steatosis was more pronounced m HCV genotype 3 patients who had intravenous drag abuse (1DU) as a risk tactor than who had blood transfusion or needle stick exposure as a risk factor (73% vs 44%), ahhough was not significant. In contrast, moderate to severe steatosis was only present in 8.7% and 85% for similar categories of patients infected with genotype 1 and 2 The cholesterol levels in patients with genotype 3 vs. genotype 1,2 were 148 +A 39.7 mg/dl vs. 171.37 +/- 40.3 mg/dl (p <0.02). There was a negative correlation between cholesterol and the grades of steatosis in all genotype. Conclusions: Moderate to severe steatosis is associated with HCV genotype 3. The patients with HCV genotype 3 infection tend to be younger. Where was no correlation between the degree of fibrosis, BMI and TG levels and severity of steatosis in all genotype. Interestingly, the patients with genotype 3 had lower levels of cholesterol when compared with genobNe 1 and 2. Patients with genotype HCV 3 who have IDU as a risk factor had a trend towards moderate to severe steatosis. M1424 Correlates of HCV Clearance in Patients with hemophilia Mingdong Zhang, James J. Goedert, Chin Chin Yuan, Thomas R. O'Brien, Elaine Eyster Patients with hemophilia were formerly at very" high risk of becoming infected with hepatitis C virus (HCV). Approximately 20% of patients infected vdth HCV (without H1V) spontane- ously clear the vires, To identity epidemiologic and clinical factors associated with spontane- ous HCV clearance, we studied HCV-int~:cted/HPv'-unmtected (HCV+/HW-) hemophilic patients enrolled m the Second Multicenter Hemophilia Cohort Study', HCV RNA detection was performed with a sensitive Taqman assay. Mukivariable logistic regression analysis was used to estimate odds ratios and 95% confidence intervals (CI). HCV RNA was undetectable m the plasma of 46 of 217 patients for a "clearance" rate of 21,2%. Adjusted for se`,'efity of bleeding diathesis and age at first treatment, patients who had received only cryoprecipitate derived from single donors had a 3.3-tbld (95% Cl 1.3~8.5) higher HCV clearance rate than patiems treated with clotting iactor concentrates derived tI'om large pools of plasma from 20,000 to 50,000 donors. In addition, adjusted tbr ty~es of treatments and for severity of bleeding, HCV clearance was 1.08dold (95% CI 1.01-114) per year higher tot patients wiLh a yom:Lgerage at first treantmnt. Females comprised only 7% of the cohort and had a non-sigmficamly, 1.9-fold higher clearance rate, In conclusion, younger age at infection and exposure to cryoprecipitates and not m commercially prepared clotting |actor concentrates were significantly related to spontaneous HCV clearance in HW negative hemophilic patients infected with HCW. These hndnigs suggest that clearance rates may be related to the quantity or the complexity of the HCV moculum. M1425 Degree of Unevenness of The Liver Surface Observed Atlaparoscopy Relates to Degree of Fibrosis of a Liver Histology for Chronic Hepatitis C Toshimitsu blurohisa, Hitoshi Sugaya, Kouji Kusano, Akira Terano, Masashi Yoneda AIM:To elucidate the laparoscopic findings indicatis'e of histological fibrosis, we compared the lapamscopic hndings and histology. Subjects and method:Subjects were 187 chronic hepatitis C pathents, who underwent laparuscopy and liver biopsy(male 114,femak73,Mean age:50.0 + -10.7y). Irregularity of the liver surface was classified to smooth liver(l), irregular liver(2(mild),3(modarete),4(severe)), and nodular liver(5). Histological findings were classi- fied without prior intbrmation by one pathologist according to Shin-lnuyama classification( Acti`,~ty:A0-A3, Fibrosis:F0-P4), Resuh:lrregularity of liver surface and histlogical fibrosis shows table 1. Grade of irregularity of the liver surface significantly correlates with those of histlogical fibrosis(Spearman rank correlation coefficient P<0.0001). Discussion:As for the therapy effect, it is known that were difti~rent by an interferon treatment tbr chromc hepatitis C by degree of fibrosis of liver histology. This study show, if irregularity of the liver surface is predsely evaluated in imaging, liver biopsy becomes usually unnecessary'. Conclusion:Irregularity of the liver suriace may be the most contributory finding to histologi- cal fibrosis in patients with chronic hepatitis C. Irregularity of liver surface (1-5)and histloglcal flbro~s(fO-F4) FO FI F2 F3 F4 1 0 0 0 0 0 2 2 38 2 0 0 3 2 58 3~ 8 0 4 0 8 8 21 1 5 0 0 0 2 1 M1426 Cost-Effectiveness of Testing Strategies for Chronic Hepatitis C Michael Chapko, Jason A. Dominitz, Kevin L Sloan, John DavismL Daniel D. Bankson, Robert D. Dufour, Michael Rigsby Purpose. This paper assesses 8 ditterent strategies for hepatitis C testing, The strategies consist of various combinations of two tests for determining the presence of antibodies (enzyme immunoassays - EtA and recombinant immunoblot assays - RIBA) and one test of viremia (reverse transcription polymemse chain reaction - PCR). Using optical density to divide EtA results into three categories (high positive, low positive, and negative) ;,,,as a/so considered. Methods. Decision analysis was used to compare the 8 strategies on tile following criteria: cost, sensitivity, positive predictive value and negative predictive value for the true hepatitis C serostatus. Parameters m the decision tree included prevalence of hepatitis C; proportion `,iremic; and sensitivity, specificity, and cost of the individual tests. Results. EIA followed by PCR for EtA positives (EtA~PCR) and the strategy that starts with EtA with three levels of optical density (EtA-OD), followed by RIBA tbr EtA low positives, and then PCR for all positives (EIA-OD--,RIBA~PCR) are the two best strategies but neither dominates the other While EtA~PCR costs an avemge of only- 2% less per individual tested and has slightly higher sensitivity (94,00% versus 93,89%), E1A-OD~R1BA~PCR has higher AASLD Abstracts A-752