LIVER DISEASE IN RESOURCE LIMITED SETTINGS

Transcription

1 LIVER DISEASE IN RESOURCE LIMITED SETTINGS MAY 29-30, 205 BUCHAREST, ROMANIA PROGRAMME & ABSTRACTS

2 CONTENTS Welcome Message 3 Committees 4 Acknowledgements / Sponsors 5 General Information 7 Scientific Programme Poster Boards 7 Invited Speakers Abstracts 25 Posters Abstracts 59 GET THE PROGRAMME & ABSTRACTS ON YOUR MOBILE DEVICE Download the Conference app 2 Programme & Abstracts Liver Disease in Resource Limited Settings

3 WELCOME MESSAGE Dear Colleagues, When we at EASL decided to have a Monothematic Conference on Liver Disease in Resource-limited Settings, we were mostly thinking about some European countries in the periphery of the EU, some neighboring countries to the East, and some areas in Africa. Since then, this term seems to apply increasingly also to countries within the heart of Europe, exemplified by the recent discussions about financing for the new therapies for hepatitis C in virtually all European nations. In fact, when we look at all the issues that have not been addressed in many of the major countries also in Western Europe and the funds it would require to engage here, the resources to effectively tackle liver disease and to really make an impact on outcome are limited in all these countries as well. As economic difficulties continue to persist, we will continue to face economic decisions in healthcare that are not necessary in the best interest of our patients. And we are also facing tough competition not only between health and other areas but also between different sectors within healthcare, where often times economists decide on the questions of where and how to invest funds most efficiently in order to obtain the most cost-effective medicine, again often times not in line with our patients needs. Since chronic liver diseases are more prevalent in less affluent areas of the world, this poses a big problem for global health and one increasing. EASL will try to elucidate some of those questions in the upcoming conference in Bucarest, where we tried to bring together experts from different stakeholders involved with battling chronic liver disease, from academia to governmental agencies and NGO s. Please come and join us at a meeting that will be somewhat different from other EASL Monothematics but that will address important questions for liver health in Europe and beyond. Prof. Markus Peck Vienna, Austria Prof. Mark Thursz London, UK EASL Monothematic Conference Bucharest, Romania May 29-30, 205 Prof. Cihan Yurdaydin Ankara, Turkey 3

4 SCIENTIFIC ORGANISING COMMITTEE Markus Peck-Radosavljevic, Vienna, Austria Mark Thursz, London, The United Kingdom Cihan Yurdaydin, Ankara, Turkey EASL GOVERNING BOARD SECRETARY GENERAL Laurent Castera, Clichy, France VICE-SECRETARY Tom Karlsen, Oslo, Norway TREASURER Mauro Bernardi, Bologna, Italy SCIENTIFIC COMMITTEE MEMBERS Alessio Aghemo, Milan, Italy Alejandro Forner, Barcelona, Spain Helen Louise Reeves, Newcastle-upon-Tyne, The United Kingdom Cecília Rodrigues, Lisbon, Portugal Frank Tacke, Aachen, Germany EDUCATIONAL COUNCILLORS Massimo Pinzani, London, The United Kingdom Cihan Yurdaydin, Ankara, Turkey EU POLICY COUNCILLOR Patrizia Burra, Padua, Italy 4 Programme & Abstracts Liver Disease in Resource Limited Settings

5 ACKNOWLEDGEMENTS PREMIUM SPONSORS EASL thanks its Premium Sponsors for their generous contributions and support of all the 205 EASL educational activities with an unrestricted educational grant. EASL Monothematic Conference Bucharest, Romania May 29-30, 205 5

6 SHOW YOUR SUPPORT FOR THE INTERNATIONAL LIVER CONGRESS Get notified

7 GENERAL INFORMATION

8 GENERAL INFORMATION GENERAL INFORMATION VENUE Hotel Novotel Bucharest City Centre Calea Victoriei 37B Sector 0006 Bucharest Romania REGISTRATION The onsite registration desk at the conference venue will be opened: Thursday, May 28 Friday, May 29 Saturday, May 30 6:00 9:00 08:00 8:45 07:30 7:00 NAME BADGES All participants are kindly requested to wear their name badges throughout the EASL Monothematic Conference in order to be admitted to the lecture halls and other scheduled activities. CME ACCREDITATION The EASL Monothematic Conference: Liver Disease in Resource Limited Settings is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS), The EASL Monothematic Conference: Liver Disease in Resource Limited Settings is designated for a maximum of (or for up to ) 2 hours of European external CME credits. 8 Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME credits to an equivalent number of AMA PRA Category Credits. Information on the process to convert EACCME credit to AMA credit can be found at Live educational activities, occurring outside of Canada, recognized by the UEMS-EACCME for ECMEC credits are deemed to be Accredited Group Learning Activities (Section ) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. The EACCME credit system is based on ECMEC per hour with a maximum of 3 ECMECs for half a day and 6 ECMECs for a full-day event. EVALUATION FORMS Session Evaluation Forms - The session evaluation forms will be available on the mobile application. CME Events Evaluation Form - These will be available online. A link will be sent to you by after the conference. Programme & Abstracts Liver Disease in Resource Limited Settings

9 Certificate of Attendance - Please note that a completed CME Events Evaluation Form is a pre-requisite in order to receive a Certificate of Attendance. Upon completion of all mandatory online evaluations, the EASL Office will send you an electronic version of your certificate by . DRESS CODE Dress code is informal for all occasions. CLIMATE The Romanian climate is continental with hot summers and harsh winters. Spring is short but very enjoyable, and May is the most recommended month to visit Bucharest with temperatures between C and 24 C approximately. BANKING The official currency in Romania is the Leu (RON). CURRENCY EXCHANGE Foreign currency can be exchanged at banks, bureau de change and automatic currency exchange machines. SMOKING POLICY This will be a non-smoking event. LANGUAGE The official language of the conference is English. SAFETY & SECURITY Please do not leave bags or suitcases unattended at any time, whether inside or outside the session halls. Hotels strongly recommend that you use their safety deposit boxes for your valuables. INFORMATION ABOUT BUCHAREST Known for its wide, tree-lined boulevards, glorious Belle Époque buildings and a reputation for the high life (which in the 900s earned its nickname of Little Paris ), Bucharest, Romania s largest city and capital, is today a bustling metropolis. Romanian legend has it that the city of Bucharest was founded on the banks of the Dambovita River by a shepherd named Bucur, whose name literarily means joy. His flute playing reportedly dazzled the people and his hearty wine from nearby vineyards endeared him to the local traders, who gave his name to the place. LIABILITY & INSURANCE The EASL Office cannot accept liability for personal accidents or loss of or damage to private property of participants. Participants are advised to take out their own personal travel and health insurance for their trip. EASL Monothematic Conference Bucharest, Romania May 29-30, GENERAL INFORMATION In order to receive a Certificate of Attendance, a CME Events Evaluation Form must be completed online.

10 ADDRESSING END-STAGE LIVER DISEASE : A MULTIFACETED CHALLENGE SEPTEMBER 25-27, 205 GLASGOW, UNITED KINGDOM ABSTRACT SUBMISSION DEADLINE JUNE 6, 205 Scientific Organising Committee Prof. M. Bernardi, Bologna, Italy Dr. R. Moreau, Clichy, France RS H AV IP AI OP LA P BL OR E TU SO ON SP For the scientific programme, online applications, and additional information please visit: NI TI ES Sign up and get notified for news and updates! EASL thanks its Premium Sponsors for their generous contributions and support.

11 SCIENTIFIC PROGRAMME

12 SCIENTIFIC PROGRAMME GET THE PROGRAMME & ABSTRACTS ON YOUR MOBILE DEVICE Download the Conference app SCIENTIFIC PROGRAMME DAY THURSDAY, MAY 28, 205 6:00 9:00 Registration DAY 2 FRIDAY, MAY 29, 205 9:00 9:30 KEYNOTE LECTURE Chairs: Markus Peck, Austria Liana Gheorghe, Romania Patient advocacy and support groups in RLS Charles Gore, The United Kingdom 9:30 0:30. EPIDEMIOLOGY OF LIVER DISEASE IN EASTERN EUROPE & AFRICA Chairs: Markus Peck, Austria Liana Gheorghe, Romania 9:30 9:45 Romania, Bulgaria, Poland and Hungary Marieta Simonova-Vasilevska, Bulgaria 9:45 0:00 Russia, Ukraine and former Soviet states TBD 0:00 0:5 Turkey Nurdan Tözün, Turkey 0:5 0:30 Africa John Ward, The United States 0:30 :00 Coffee Break 2 Programme & Abstracts Liver Disease in Resource Limited Settings

13 :00 2:45 2. ALCOHOLIC LIVER DISEASE, NAFLD AND HCC IN EASTERN EUROPE: MANAGEMENT :00 :5 Alcoholic Liver Disease in Eastern Europe TBD :5 :30 NAFLD in Eastern Europe Vlad Ratziu, France :30 :45 Non-Invasive evaluation Laurent Castera, France :45 2:00 Advanced stage liver disease Bogdan Procopet, Romania 2:00-2:5 Is cancer surveillance appropriate for RLS? Yes: Markus Peck, Austria No: Olufunmilyo Lesi, Nigeria 2:5 2:45 KEYNOTE LECTURE 2 SCIENTIFIC PROGRAMME Chairs: Cihan Yurdaydin, Turkey Marina Maevska, Russia ECDC Strategies to tackle Viral Hepatitis in Eastern Europe TBD 2:45 3:30 Lunch 3:30 5:05 3. SCREENING / CASE FINDING / PREVENTION FOR VIRAL HEPATITIS Chairs: TBD 3:30 3:55 Viral Diagnostics; what do we need and what is required? Isabelle Chemin, France 3:55 4:20 What are the skills gaps in RLS Philipp Bruggmann, Switzerland 4:20 4:45 Iatrogenic transmission in RLS - how can it be prevented Arnaud Fontanet, France 4:45 5:05 Discussion 5:05 6:30 Coffee break EASL Monothematic Conference Bucharest, Romania May 29-30, 205 3

14 6:30 8:30 4. PUBLIC HEALTH / GLOBAL HEALTH PERSPECTIVE ON VIRAL HEPATITIS SCIENTIFIC PROGRAMME Chairs: Stefan Wiktor, Switzerland John Ward, The United States 6:30 7:00 How to improve access to affordable HCV treatment? Peter Beyer, Switzerland 7:00 7:30 HCV medicines: A market dynamics perspective Karin Timmermans, Switzerland 7:30 8:00 A health-systems approach to scaling-up hepatitis treatment Stefan Wiktor, Switzerland 8:00 8:30 Discussion DAY 3 SATURDAY, MAY 30, 205 8:00 9:30 5. STANDARD TREATMENT OF VIRAL HEPATITIS Chairs: Mark Thursz, The United Kingdom Krum Katzarov, Bulgaria 8:00 8:30 Standard treatment of Hepatitis B and Delta Heiner Wedemeyer, Germany 8: Standard treatment of Hepatitis C Alessio Aghemo, Italy 9:00-9:30 Drug abuse and chronic viral hepatitis in RLS Natasha Martin, UK 9:30 0:00 KEYNOTE LECTURE 3 Tackling alcoholic liver disease in Eastern Europe Annalisa Belloni, France 0:00 0:20 Coffee break 0:20 2:20 6. HEPATITIS B, HEPATITIS C AND DELTA: SPECIAL ISSUES IN RLS Chairs: Heiner Wedemeyer, Germany Irinel Popescu, Romania 0:20 0:50 Hepatitis B and Delta Cihan Yurdaydin, Turkey 0:50 :20 Hepatitis C Mark Thursz, The United Kingdom 4 Programme & Abstracts Liver Disease in Resource Limited Settings

15 :20 :50 HIV-Coinfection Patrick Ingliz, Germany :50-2:20 Fake drugs for viral hepatitis in Eastern Europe TBD 2:20 3:00 Lunch 3:00 5:30 7. TREATMENT IMPLEMENTATION PROGRAMS IN RLS 3:00 3:25 Cost-effectiveness and patient prioritization Yazdan Yazdanpanah, France 3:25 3:50 Project in Mozambique and several resource limited settings Isabelle Andrieux-Meyer, Switzerland 3:50 4:5 Implementation projects in IVDU s Julie Bouscaillou, France 4:5 4:40 HBV-Implementation Program Senegal, Gambia, Nigeria Ramou Njie, Gambia 4:40 5:05 HCV-Program Senegal, Cameroon and Cote d Ivoire Karine Lacombe, France 5:05 5:30 Discussion 5:30 5:50 Coffee break 5:50 6:50 SCIENTIFIC PROGRAMME Chairs: Alessio Aghemo, Italy Angelos Hatzakis, Greece 8. LIVER TRANSPLANTATION PROGRAMS IN EASTERN EUROPE Chairs: Patrizia Burra, Italy Mark Thursz, The United Kingdom 5:50 6:05 Poland Jerzy Jaroszevicz, Poland 6:05 6:20 Romania Irinel Popescu, Romania 6:20 6:35 Russia TBD 6:35 6:50 Development of a National Liver Disease Management Program in Kazakhstan Alexander Nersesov, Kazakhstan EASL Monothematic Conference Bucharest, Romania May 29-30, 205 5

16 THE LEADING LIVER ASSOCIATION IN EUROPE APPLY FOR AN EASL FELLOWSHIP PROGRAMME! Post-Doc Research Fellowships Entry-Level Research Fellowships Physician Scientist Fellowships Application open from April 30 - June 30 Short-Term Research Fellowships EASL Mentorships The Dame Sheila Sherlock EASL Fellowship programmes aim to enhance the mobility of investigators within different European institutions, actively promote scientific exchange among research units in Hepatology, and enable physician scientists to take leave from clinical duties to spend 6-2 months in a research laboratory. EASL EDUCATIONAL ACTIVITY No restrictions on applicant s nationality Leading European hosting institutions Open to all registered EASL members Up warded 000 a to 40 For application conditions, deadlines and details visit EASL thanks its Premium Sponsors for their generous contributions and support of the EASL Fellowship Programme

17 eposter LIST

18 eposter LIST Abstract Poster Title Abstract Presenter P0 YI PRIORITIZATION OF SCREENING PROGRAMS OF HCC AND LIVER FIBROSIS IN EGYPTIAN PATIENTS WITH CHRONIC HEPATITIS USING DATA MINING TECHNIQUES Abubakr Awad P02 LIVER TRANSPLANTATION EXPERIENCE IN REPUBLIC OF MOLDOVA: ISSUES AND ACHIEVEMENTS Angela Peltec P03 VITAMIN B2 SUPPLEMENTATION BOOSTS FIRST CLASS DIRECT-PROTEASE INHIBITORS EFFECT IN HEPATITIS C VIRUS CIRRHOTIC PATIENTS Alba Rocco P04 YI EFFECT OF ANTIVIRAL THERAPY ON LIVER FIBROSIS IN PATIENTS WITH CHRONIC HCV INFECTION Alexandra Floriana Rosu P05 YI HBSAG AND HBEAG SEROCLEARANCE IN TREATED PATIENTS WITH HEPATITIS B VIRUS AND HIV CO-INFECTION IN SUB-SAHARAN AFRICA Anders Boyd P06 YI IDENTIFYING PATIENTS INFECTED WITH HEPATITIS B VIRUS IN SUB-SAHARAN AFRICA: POTENTIAL FOR MISCLASSIFICATION Anders Boyd P07 EFFICACY AND SAFETY OF TRANSARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH INTERMEDIATE AND ADVANCED STAGES HEPATOCELLULAR CARCINOMA Chalermrat Bunchorntavakul 8 Programme & Abstracts Liver Disease in Resource Limited Settings

19 Poster Title P08 THE CHANGING PATTERN OF GENOTYPE Dimitrios DISTRIBUTION AMONG CHRONIC HCV Dimitroulopoulos INFECTED PATIENTS IN GREECE DURING THE LAST 2 YEARS AND HIS POSSIBLE IMPACT IN THE NATIONAL HEALTH ECONOMICS IN THE ERA OF CRISIS. P09 YI MORPHOLOGICAL FEATURES OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS. Dzmitry Haurylenka P0 YI THE ALCOHOL CONSUMPTION IN PATIENTS WITH CHRONIC B AND C HEPATITIS Elena Cristina Rezi P PROFILING CHRONIC HCV PATIENTS FOR NEW THERAPIES Elena Laura Iliescu P2 THE ROLE OF AUTOANTIBODIES (AAB) TO NON-SPECIFIC PROTEIN (NSP) IN THE PATHOGENESIS OF HEPATIC ENCEPHALOPATHY (HE) Elina Manzhalii P3 YI RISK FACTORS FOR RECURRENCE OF HEPATOCELLULAR CARCINOMA AFTER RADIOFREQUENCY ABLATION IN A COHORT OF EGYPTIAN PATIENTS WITH HEPATITIS C VIRUS-INDUCED CIRRHOSIS: A DOUBLE CENTER ANALYSIS. Eslam Habba P4 BURDEN OF DISEASE PRESENTING TO THE FIRST LIVER CLINIC ESTABLISHED IN BOTSWANA Sandro Vento EASL Monothematic Conference Bucharest, Romania May 29-30, 205 Abstract Presenter eposter LIST Abstract 9

20 eposter LIST Abstract Poster Title Abstract Presenter P5 DOES THE SIZE OF THE EVALUATION BOX INFLUENCES THE RESULT OF 2D- SHEAR WAVE ELASTOGRAPHY Ioan Sporea P6 SHEAR-WAVE ELASTOGRAPHY FOR THE Ioan Sporea ESTIMATION OF LIVER FIBROSIS IN CHRONIC VIRAL LIVER DISEASES P7 THE BEST NEEDLE SIZE FOR THE BEST LIVER BIOPSY TISSUE SAMPLE Ioan Sporea P8 YI MANAGEMENT OF PRIMITIVE LIVER TUMOURS IN A SINGLE CENTER IN ROMANIA Letitia Toma P9 ACUTE KIDNEY INJURY (AKI) IN 326 HOSPITALIZED PATIENTS WITH DECOMPENSATED CIRRHOSIS (CI): FREQUENCY, ASSOCIATIONS, MORTALITY Lubomir Skladany P20 BULGARIAN MODEL FOR THE DIAGNOSIS, Marieta Simonova TREATMENT AND MONITORING OF PATIENTS WITH CHRONIC VIRAL HEPATITIS, WHO ARE DIAGNOSED WITH OPIOID DEPENDENCE AND UNDERGO OPIOID SUBSTITUTION TREATMENT P2 YI CLINICAL SCORES FOR THE PREDICTION OF ESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS Milica Stojkovic P22 YI CLINICAL PATTERN OF HEPATOCELLULAR CARCINOMA IN YOUNG PATIENTS; A TWO YEAR STUDY Pantong Mark Davwar 20 Programme & Abstracts Liver Disease in Resource Limited Settings

21 Abstract Poster Title Abstract Presenter P23 LIVER ENRICHED TRANSCRIPTION FACTORS - MOLECULAR MARKERS FOR HEPATOCELLULAR CARCINOMA RECURRENCE AFTER LIVER TRANSPLANTATION AND LIVER RESECTION Razvan Iacob P24 YI WHAT IS REQUIRED FOR CONTROL AND ELIMINATION OF HEPATITIS B GLOBALLY? Shevanthi Nayagam P25 PREVALENCE OF HEPATITIS C CO-INFECTION Sokkab An IN HIV PATIENTS IN PHNOM PENH, CAMBODIA. PRELIMINARY FINDINGS. P26 RECIPIENT AND DONOR FACTORS PREDICTING POST-TRANSPLANT SURVIVAL IN THE ROMANIAN NATIONAL TRANSPLANT PROGRAM P27 ANTICOAGULANT THERAPY AND OUTCOME Speranta Iacob OF PATIENTS WITH LIVER CIRRHOSIS AND NON-MALIGNANT PORTAL VEIN THROMBOSIS P28 TREATMENT OF SEVERE RECURRENT HEPATITIS C IN LIVER TRANSPLANT RECIPIENTS USING NEW ANTIVIRALS LIMITED EXPERIENCE OF A LARGE VOLUME TRANSPLANTATION CENTRE IN A LRS Speranta Iacob P29 OUTCOME OF TRANS-ARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH LIVER CIRRHOSIS AND HEPATOCELLULAR CARCINOMA Speranta Iacob EASL Monothematic Conference Bucharest, Romania May 29-30, 205 eposter LIST Speranta Iacob 2

22 eposter LIST Abstract Poster Title Abstract Presenter P30 YI SINGULAR PRESENTATION OF HEPATITIS B NATURAL HISTORY: PRES2 DELETION AND HCC IN THE WEST-AFRICA Sumantra Ghosh P3 YI EFFICACY OF ENTECAVIR/TENOFOVIR FOR NUCLEOS(T)IDE-EXPERIENCED PATIENTS WITH CHRONIC HEPATITIS B IN REAL WORLD SETTING- EXPERIENCE FROM A TERTIARY CARE CENTER IN INDIA Sundeep Kumar Goyal P32 POSSIBILITY FOR ASSESSING HEPATIC FIBROSIS IN CHRONIC HEPATITIS C BY DETERMINING CYTOKINES Vladimir Shchekotov P33 POSSIBILITY FOR ASSESSING HEPATIC FIBROSIS IN CHRONIC HEPATITIS C BY DETERMINING CYTOKINES Vladimir Shchekotov P34 MICRORNAS DESREGULATION IN NONALCOHOLIC FIBROSING STEATOHEPATITIS Yuemin Nan P35 PLASMA LONG NON-CODING RNA-ATB IS ASSOCIATED WITH LIVER FIBROSIS PROGRESSION IN PATIENTS WITH CHRONIC HEPATITIS C Yuemin Nan P36 MODULATION OF IL-23/TH7 AXIS INVOLVES IN CHRONIC HEPATITIS C VIRUS INFECTION Yuemin Nan P37 FIBROTOUCH IS SUPERIOR TO APRI AND FIB-4 Yuemin Nan FOR THE EVALUATION OF LIVER FIBROSIS IN PATIENTS WITH CHRONIC VIRAL HEPATITIS 22 Programme & Abstracts Liver Disease in Resource Limited Settings

23 Poster Title Abstract Presenter P38 EMPERIPOLESIS MEDIATED BY CD8+ T CELLS Yuemin Nan CORRELATED WITH BILIARY EPITHELIA CELL INJURY IN PRIMARY BILIARY CIRRHOSIS P39 HEPATITIS E VIRUS INFECTION IS ENDEMIC, BUT NOT A COMMON CAUSE OF ACUTE DECOMPENSATION OF LIVER CIRRHOSIS IN THE GAMBIA, WEST AFRICA Yusuke Shimakawa P40 YI CLINICAL PREDICTIVE VALUE OF INSULIN SECRETION CHARACTERISTICS AND ABNORMAL GLUCOSE METABOLISM OF NAFLD PATIENTS Shang-Yu Chai eposter LIST Abstract EASL Monothematic Conference Bucharest, Romania May 29-30,

24 JOIN EASL AND CONNECT WITH A VAST COMMUNITY OF EXPERTS IN HEPATOLOGY As an EASL member you will enjoy the following benefits: Access to the online version of the Journal of Hepatology* Reduced registration fees to The International Liver Congress (ILC) and all EASL Meetings Opportunity to organise EASL Monothematic Conferences and EASL Special Conferences** Chance to host one of the EASL Schools of Hepatology** Free access to the LiverTree Free weekly e-newsletter Possibility to host fellows as part of the EASL Fellowship Programme EU funding and application support for the EU Research Framework Programme Application to the EASL Mentorship programme Funding opportunities (endorsed and sponsored events, registry grant application) BECOME A MEMBER TODAY! Take an active role in the most forward thinking and dynamic hepatology community wordwide! * Members wishing to receive printed copies of the Journal of Hepatology can opt for the paper version for an additional 50 per year. **Members can host EASL Schools, and organise Monothematic and Special Conferences (subject to EASL Governing Board approval) Visit for more information.

25 INVITED SPEAKERS ABSTRACTS

26 KN PATIENT ADVOCACY AND SUPPORT GROUPS IN RESOURCE LIMITED SETTINGS Charles Gore* N/A, The World Hepatitis Alliance, Genève 6, Switzerland Corresponding author s charles.gore@worldhepatitisalliance.org SPEAKERS ABSTRACTS Patient advocacy and support groups tend to be few and small in resource limited settings (RLS), partly because of a general paucity of resources and partly because of a less well-established culture of patient involvement. The World Hepatitis Alliance s 204 Global Community Hepatitis Policy Report highlighted how under-developed the patient community currently is in viral hepatitis. Yet the need for viral hepatitis patient groups has never been greater. In response to World Health Assembly resolution 67.6, the World Health Organization has drafted a Global Health Sector Strategy for viral hepatitis. It has aggressive targets for diagnosis and treatment for both hepatitis B and C with an aim of eliminating these two diseases as major public health concerns by To meet those targets a huge scale up of services in RLS will be required and this in turn will a vastly increased contribution from patient groups, especially in sharing the burden of proving information and support, and even service delivery, with healthcare professionals. Even more critically, the targets will require a level of resource mobilization that only strong advocacy can possibly deliver, whether those resources are to come from global funding bodies, from reallocation within domestic health budgets or from innovative mechanisms. Patient advocacy will be key to ensuring the necessary political will. Creating new patient groups where none exist and supporting the existing ones to grow is therefore vital to all those involved in viral hepatitis. Doing so is one of the roles of organisations like the World Hepatitis Alliance but healthcare professionals working in the field also have an important role. It is healthcare professionals who are in contact with patients, who can potentially help them get together to begin the process of forming a group and who can support them with experience, professionalism and contacts. Too often healthcare professionals never consider this as something they could and should take on, thinking of advocacy as someone else s job. This needs to change and the World Hepatitis Alliance has produced a new online Patient Advocacy and support group Creation Tool (PACT) to explain why healthcare professionals should take this on and guide them through the process. 26 Programme & Abstracts Liver Disease in Resource Limited Settings

27 Right now, we are merely tinkering round the edges of viral hepatitis, making no impact at all on the burden in RLS. Without a much stronger patient group community viral hepatitis will never have the priority and resourcing to change that. SPEAKERS ABSTRACTS Disclosure of Interest: C. Gore: Grant/Research Support: The World Hepatitis Alliance receives support from Gilead, BMS, AbbVie, Janssen, Merck but I receive none and am unpaid EASL Monothematic Conference Bucharest, Romania May 29-30,

28 O0 EPIDEMIOLOGY OF LIVER DISEASES: ROMANIA, BULGARIA, POLAND AND HUNGARY Marieta Simonova* Clinic of Gastroenterology, Miliary Medical Academy, Sofia, Bulgaria Corresponding author s simonova_m@yahoo.co.uk SPEAKERS ABSTRACTS According to the WHO in 20 the average mortality from chronic liver disease and cirrhosis in European Union (EU) per 00,000 persons was 8,78 for males and 7,29 for females. Romania had the highest cirrhosis mortality rate in EU for both males and females (65,69 and 30,8 respectively), followed by Hungary (53,82 for males and 6,36 for females). Bulgaria and Poland had also higher mortality rates for males, than average in EU (27,08 and 22,4, respectively). The time-trends in cirrhosis mortality rates in four reported countries had showed similar pattern with an increase since 970 until the mid90s and with subsequent decrease after that, illustrating the effects of the main risk factors for the development of liver cirrhosis (alcohol consumption and infections with hepatitis B and C viruses). The average incidence rates for primary liver cancer per 00,000 persons in EU were 7,6 and 2,4 for males and females, respectively in 202, according to GLOBOCAN data. The incidence rates of liver cancer were lower than EU levels in Hungary (5,6 for males and,5 for females), Poland (3,8 for males and 2,0 for females) and in Bulgarian males (6,4). Bulgarian females had same incidence as average EU rate 2,4. In Romania incidence rates for liver cancer was 9,2 for males and 3,0 for females per 00,000 persons. According to the ELTR data ( /205) liver cirrhosis was the indication for LT in 75% of cases in Hungary, 68% of cases in Romania, 54% of cases in Bulgaria and 5% cases in Poland. The five main etiologies of liver cirrhosis, led to LT were: in Romania HCV infection - 32,8%, HBV infection 6,%, HBV/HDV infection-25%, alcohol 6,7% and cryptogenic cirrhosis - 4,9%; in Bulgaria alcohol 32,4%, HCV infection 6,2%, HBV infection 3,5%, secondary biliary cirrhosis 6,8% and PSC 6,8%; in Poland HCV infection 27,7%, HBV infection 8,8%, alcohol 8,%, PSC 0,8%, PBC 9,0%. Primary liver cancer was an indication for LT in,7% of cases in Romania, 2% of cases in Poland, 5% of cases in Hungary and 6,8% of cases in Bulgaria. 28 Programme & Abstracts Liver Disease in Resource Limited Settings

29 Infections with viral hepatitis B and C viruses are major causes for liver diseases in Romania, Bulgaria and Poland. In Romania prevalence of HCV in general population is 3,23%, prevalence of HBV is 4,4 % and prevalence of HDV is 2,3%. A study in 085 Romanian patients in waiting list for LT in and , showed that HBV infection (with or without HDV co-infection) was a main reason for liver cirrhosis (42% and 4%, respectively), followed by HCV infection (30% and 32.8%, respectively) and alcohol use (2% and 6.7% respectively). The prevalence of HCV and HBV infections in Bulgaria were,28% and 3,87%, respectively in a multicentre study conducted in A study from 2000 in 930 Bulgarian cirrhotic patients showed that HCV and HBV infection were present in 2,9% and 9,5% of patients, respectively. Two independent, epidemiological studies were performed in Poland between , evaluating HCV prevalence in the adult population. The results from one study showed HCV seroprevalence of,9%, but positive HCV RNA in only 0,6% of the investigated population. Second study showed HCV seroprevalence of 0,89%. The data about HBV prevalence in Poland vary between 0,79% to,2%. Hungary is low-prevalent country for both HCV (0,6%) and HBV infections (0,7%), but no recent epidemiological data are available. Currently in all four counties, the main routes for transmission of HCV infection are intravenous drug use and nosocomial transmission and for HBV infection heterosexual transmission (3,2%) and nosocomial transmission (20,6%) for the acute cases and mother to child transmission (67%) for the chronic cases. In all four countries there is steady decline in the HBV infection incidence of the acute cases in the last 20 years. It is anticipated that NAFLD may represents a significant potential threat to public health in reported countries, since about one quarter of the population there is obese. However, there are no major studies on the prevalence of NAFLD in Bulgaria, Hungary and Poland. In Romania a hospital-based study encompassed 3005 patients, found an overall prevalence rate of NALFD of 20% based on ultrasound examination. Autoimmune liver diseases, as well as hereditary metabolic diseases are not very frequent in Romania, Bulgaria, Hungary and Poland. Infections with HCV and HBV and harmful alcohol consumption are the main causes for the significant liver disease burden in Romania, Bulgaria, Poland and Hungary, however each of these causes is amendable to prevention and treatment. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS The alcohol attributable liver cirrhosis deaths, according to WHO in 200 in males and in females, respectively were: in Romania 77,8% and 60,9%; in Bulgaria 74,8% and 59,2%; in Poland 76,5% and 59% and in Hungary 76,9% and 66,7%. These figures put the reported countries among the ones with the heaviest burden of alcoholic liver disease in Europe.

30 O03 EPIDEMIOLOGY OF LIVER DISEASES IN TURKEY Nurdan Tozun* Acıbadem University, Istanbul, Turkey Corresponding author s nurdan.tozun@acibadem.edu.tr SPEAKERS ABSTRACTS Liver diseases are commonly encountered in Turkey but the lack of a reliable recording system makes the estimation of DALY s of these disorders quite difficult. Liver related deaths constitute almost 22 % of GI system related deaths and 0.5 % of all causes of mortality according to the last statistics of the MoH. Although alcohol and obesity seem to be rampant in western world as cause of liver injury Hepatitis B and C are still the leading cause for liver cirrhosis (LC) and HCC in Turkey and its neighborhood. The true incidence and prevalence of viral hepatitides is not well known in Eastern Europe including Turkey. For such an important health issue it is crucial to know the magnitude of the problem since viral hepatitis B and C may progress to chronicity and end up with liver cirrhosis and HCC. Additional hurdles related to the problem are the lack of public awareness about hepatitis, insufficient interest of health authorities towards the disease and the high cost of the available treatments. With current and emerging therapies, Hepatitis B and C are eminently curable or at least suppressible. But the antivirals are prohibitively expensive especially for HCV at the moment and this has been perhaps one of the reasons for the public health authorities and policy makers in countries with limited resources to underappreciate the problem of hepatitis. Turkey is considered as a country of intermediate endemicity for hepatitis B and low endemicity for hepatitis C. Based on data derived mainly from studies in blood donors, the overall prevalence of chronic HBV infection has been reported to range from 4% to 5% in Turkey with considerable regional differences such as a high incidence in East as opposed to West. There is decline in HBV prevalence due to effective preventive measures and universal vaccination programme. Health Statistics Yearbook 200 revealed the incidence of hepatitis B infection to be 8.26 by 2002 and 4.2 by 200 per 00,000 population. A recent nationwide,population based study carried out in 547 healthy subjects by The Turkish Association for the Study of the Liver showed a seropositivity rates of 4 % for HBsAg,.0% for HCV, 93.2 % for HAV reaching 00 % in people over 70 years, 2.75 % for HDV in those who are HBsAg positive. Almost /3 of the population has been in contact with HBV. Risk factors for HBV infection were close contact with hepatitis patient, living in southeastern region, being married, educational level 30 Programme & Abstracts Liver Disease in Resource Limited Settings

31 There are over 4 liver transplantation centers in Turkey.Annual number or liver transplantation in 204 was about 400 with HBV and HCV occupying the first rank and Turkey has the highest number of living donor liver transplants (>80 %). In conclusion, there is a need for large scale epidemiological studies in Turkey about liver diseases.hbv and HCV are still a major threat for liver diseases and NAFLD related liver problems seem to increase in concordance with rising obesity and metabolic syndrome. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS higher than high school, orodental interventions and use of non-disposable syringe history whilst age > 50 was the only predictor for HCV positivity. Previous studies had shown high impact of blood transfusion, surgery and orodental interventions in HCV transmission. IVDU is relatively low in Turkey. The majority of chronic HCV infections are of genotype b, with estimates ranging between 75 to 90%. Our HBV subjects are of Genotype D (99. %) and 94.5% are anti HBe positive. Horizontal and vertical transmission are the main route of transmission for HBV. Universal vaccination programme for HBV implemented since 998 in Turkey has reached a coverage rate of 97% by the year 203. All HBV drugs are approved by the MoH and covered by National Security Institution (NSI).Screening for HBV and HCV has been available in blood banks since since 97 and 996 respectively.screening is done routinely to pregnant women, to couples prior to marriage and to HC workers.public awareness and political attention is still unsatisfactory regarding hepatitis infection and the high cost of new DAA s precludes their reimbursement by the NSI.Furthermore only 7 % of HCV RNA + patients have access to treatment. According to the national records, the annual number of HCC patients is estimated to be 500 with % of them being related to HBV, 5-20 % to HBV and HDV, 2-25 % to HCV infection and the rest to other causes. Few studies have shown the increasing contribution of NAFLD and that of aflatoxin B to HCC development.obesity and NAFLD have a rising trend in Turkey. The international multicenter PURE study reported an overall prevalence of 44 % for metabolic syndrome.a biopsy based regional study revealed 59 % of fibrosis (% severe) in NASH patients. On the other hand annual consumption of alcohol (.58 L/per capita) also tends to rise but the impact of alcohol on liver diseases is still relatively low. (5% in LC and 6.6% in HCC).

32 O04 LIVER DISEASE IN AFRICA John Ward* CDC, Division of Viral Hepatitis, Atlanta, United States SPEAKERS ABSTRACTS Corresponding author s jward@cdc.gov Persons in most countries of sub-saharan Africa (SSA) are at increased risk of hepatitis B virus ( HBV) and hepatitis C virus ( HCV) virus infection and the diseases related to these infections particularly hepatocellular carcinoma (HCC). Migrants from these countries have similar risks. The prevalence of HBsAg + persons is approximately 7% in SSA with regional variations from 6.78 % in central SSA to 7.99 % in the west. In the absence of infant hepatitis B vaccination coverage, the HBsAg prevalence is high in young age cohorts (<5 years of age) reflecting perinatal and horizontal transmission and the increased risk of chronic HBV infection for this age group. Hepatitis B vaccine has been added to the infant immunization schedule in many African countries; however, birth dose coverage remains low. Transmission of both HBV and HCV occurs in health care settings. The risk of transmission for HBV and HCV from donated blood is estimated at 4.3 and 2.5 infections per 000 units, respectively; most of this risk represents inadequate screening practices. Studies suggest HCV has been present in SSA for over 500 years and a diversity of genotypes in circulation. HCV prevalence varies regionally from an estimated 6.76% in central SSA to 0.9 % in the south and east. HCV prevalence can also vary within countries reflecting differences in exposures within health care settings and perhaps cultural practices and household contacts that increase risk of HCV transmission. Of HIV-infected persons an estimated 5.73% and 7.8% are co-infected with HCV and HBV, respectively. Approximately 90% of HCC is related to HBV and HCV infection. As a result, SSA has one of the highest HBV-related liver cancer rates in the world with liver cancer the most common cancer among males and third most common cancer among females. Additional epidemiologic data, public health planning, and capacity building will be required for countries in SSA to implement HBV and HCV, testing, care, and treatment and reduce the burden of HCC and other diseases related to HBV and HCV infection. 32 Programme & Abstracts Liver Disease in Resource Limited Settings

33 O07 NON-INVASIVE EVALUATION Laurent Castera*, 2 Service d Hépatologie, Hôpital Beaujon, AP-HP, Clichy, 2Université Paris Diderot, Paris, France Corresponding author s laurent.castera@bjn.aphp.fr Disclosure of Interest: L. Castera: Sponsored Lectures: National or International: Echosens, Biopredictive EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS A common clinical concern in patients with NAFLD is whether they have NASH or simple steatosis and, more importantly, what the stage of fibrosis is and whether the level of fibrosis has increased over time. Such concern is based on the fact that patients with NAFLD with advanced fibrosis are at greatest risk of developing complications of end-stage liver disease. Although it lacks sensitivity, ultrasonography is an accepted tool for steatosis screening. The controlled attenuation parameter or CAP seems a promising screening technique, but requires further validation. Cytokeratin-8 has been extensively validated, but it is an imperfect serum marker of NASH. Ultrasonography-based transient elastography can exclude advanced fibrosis and cirrhosis, but its main limitation is its reduced applicability in patients with NAFLD, which is not completely solved by use of the XL probe. Of the noninvasive serum markers, the NAFLD fibrosis score is the most validated and has appropriate accuracy in distinguishing patients with and without advanced fibrosis. Although noninvasive methods require further validation, they could be useful for selecting those patients with NAFLD who require a liver biopsy.

34 O08 ADVANCED STAGE LIVER DISEASE Bogdan D. Procopet*, 2, 3 Gastroenterology, University of Medicine and Pharmacy Iuliu Hatieganu» 3rd Medical Clinic, 2 Hepatology, Regional Institute of Gastroenterology and Hepatology «O. Fodor», Cluj-Napoca, Romania, 3 Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain SPEAKERS ABSTRACTS Corresponding author s bogdanprocopet@gmail.com Advanced stage liver disease (ASLD) represents the moment in the natural history of any progressive chronic liver disease when patients should be referred for the screening of portal hypertension related complications (high risk esophageal varices) and surveillance of hepatocellular carcinoma. ASLD covers a large spectrum of manifestation and stages, from compensated stage characterized by low liver related mortality, to decompensated stages and end-stage liver disease that is dominated by high mortality and will eventually benefit from liver transplantation. The key point in the evaluation and the management of these patients is represented by risk stratification that would select patients at risk for developing complications and which would allow a better allocation of diagnostic resources, an essential problem in settings with limited resources. For the moment, the best method that was proved to accurately evaluate the risk of patients with ASLD is the measurement of hepatic venous pressure gradient (HVPG). HVPG was recently accepted as surrogate marker for guiding the development of new treatments and strategies for patients with ASLD. However, the availability of HVPG is reduced worldwide, especially in resource limited settings and, therefore, lately non-invasive methods became available. Simple clinical and laboratory findings were recently proved to be efficient in the risk stratification of decompensated stages and allowed the selection of patients for certain treatment strategy. Indeed, risk stratification should be easy to apply in clinical practice and to be general available and thus to better manage the treatment resources. Although the diagnostic and the management of ASLD follows general rules regardless the etiology, in case of alcoholic liver disease (ALD) or NAFLD there are some particularities. Regarding the diagnostic of ALD it is still challenging to differentiate between alcoholic hepatitis and decompensated alcoholic cirrhosis. In this case liver biopsy is still the best diagnostic methods. When possible, it is preferably to be performed using the transjugular route, so it can be combined in the same time with HVPG measurement. An important aspect of the management of alcoholic ASLD is represented by the abstinence from alcohol intake that may improve prognosis over time and it is mandatory before considering liver transplantation. 34 Programme & Abstracts Liver Disease in Resource Limited Settings

35 SPEAKERS ABSTRACTS Due to high prevalence of overweight and obesity worldwide, NAFLD is becoming one of the leading etiologies of ASLD, especially in developed countries where in the next years viral etiology is expected to decrease once the new antiviral drugs are becoming widely available. However, in a considerable number of countries with limited resources the prevalence of obesity is close to the level of developed countries and, therefore, the lower proportion of NAFLD may be only because of a dilution effect of the still high prevalence of viral etiology. One of the most important directions of the management of NAFLD patients is represented by lifestyle modification, which is effective for prevention of complications in early stages. Recently, it was proved that patients with ASLD and obesity have increased risk of clinical decompensation and lifestyle modification (sport and diet) decrease portal pressure. However, in decompensated stages these patients are at high risk of malnutrition, mainly because low adherence to the nutritional recommendation, and that impairs further the prognostic. Therefore, nutritional evaluation and support should be part of the general management of patients with ASLD and should be apply in every stage of the disease. It is a very cheap method and it should be easy to implement in limited resource settings. In conclusion, once ASLD is diagnosed, evaluation of decompensation risk should be made and, according to the stage and the presence of associated prognostic factors - appropriate interventions should be made in order to decrease the risk of further complications and liver related death. EASL Monothematic Conference Bucharest, Romania May 29-30,

36 O0 DEBATE: IS HCC SURVEILLANCE APPROPRIATE FOR RESOURCE LIMITED SETTINGS (RLS)? NO Olufunmilayo Lesi*, Pelumi okuyemi2 medicine, Lagos University Teaching Hospital, Lagos, 2medicine, Lagos university Teaching Hospital, idi-araba, Lagos, Nigeria Corresponding author s fulesi2@yahoo.com Background: Hepatocellular carcinoma (HCC), is the third leading cause of cancer deaths worldwide, with prevalence 6 32 times higher in developing countries than in developed countries. Sub-Saharan Africa is the most affected region of the world, after Eastern Asia owing to the high prevalence of risk factors for this cancer in these continents. In Western countries, HCC surveillance and evaluation is performed in liver referral centers with appropriate human and technical resources. The objective of this presentation is to evaluate the role of HCC surveillance as an appropriate strategy for HCC control in resource-limited setting. SPEAKERS ABSTRACTS Methods: Review of various international guidelines for HCC surveillance and the recently released WHO guidelines for RLS recommend the combination of ultrasound and AFP monitoring at approximately 6-monthly intervals to detect HCC in the early stages and improve overall survival through earlier potentially effective therapies. Discussion: Many of the population and non-population-based cohorts and cost effectiveness analysis used for the development of the guidelines suffer from methodological biases such as lead-time bias and other inconsistencies that reduce the quality of the evidence. Furthermore, in RLS, the lack of technological, financial and infrastructural support needed to manage complications of advanced liver disease and treat HCC may render surveillance less effective. Conclusion: In resource-limited countries where potentially curative treatment is unavailable, primary prevention should be a priority for HCC control. The feasibility of HCC surveillance requires significant planning and strengthening of public health services. 36 Programme & Abstracts Liver Disease in Resource Limited Settings

37 O VIRAL DIAGNOSTICS; WHAT DO WE NEED AND WHAT IS REQUIRED? Isabelle Chemin* Centre de recherche en cancérologie de Lyon, INSERM U052, Lyon, France Corresponding author s isabelle.chemin@inserm.fr If hepatitis cases remain numerous in high-income countries, vaccination strategies, treatments and diagnosis slowly decrease the number of unknown status that seed the future cases of severe and terminal disease. However the majority of the millions of people that live with viral hepatitis and exposed to, were mostly found in low income countries, hepatitis B being the major causal agent. Due to a lack of implementation of the strategy to identify the chronic carriers of hepatitis viruses most HBV or HCV patients are unaware of their chronic infection although they are at high risk of developing severe chronic liver disease and continue to transmit the infection to other people. Some groups are at more risk of contracting viral hepatitis than others. In addition, in communities where food and sanitation conditions are not optimal, hepatitis A and E tend to be more common. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS Around people die each year (~2.7% of all deaths) from viral hepatitis associated diseases, most commonly liver disease, including liver cancer. In the world, approximately 500 millions people are chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). An estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer are induced by HBV or HCV infection. Despite liver diseases represent a major public health problem, it have not been addressed properly for several reasons. The discovery of the causative viruses is relatively recent, the disease in its early stages remains benign or silent and it progress through a long process that last for decades after infection. A high proportion of chronic carriers are living in countries where the access to the health system is difficult due to economic and/or geographic constraints. It is not rare that people are seen for the first time in a clinical setting at a end-stage of liver disease including liver cancer. For all those reasons viral hepatitis consist in a kind of silent epidemic. In 200 the World Health Assembly adopted a resolution calling for a comprehensive approach to the prevention and control of viral hepatitis recognizing the tremendous burden of viral hepatitis.

38 A number of solutions may exists including vaccination, safe blood supply, safe injections, and safe food but this relies on the improvement of the assessment of global and regional economic impacts and estimates of the burden of viral hepatitis to develop the necessary guidelines, strategies, and tools for the surveillance, prevention and control of viral hepatitis. Those tools do include Point-of-care testing of quality, robust molecular tests, it is essential that those tools are easy to handle, not expensive and efficient. SPEAKERS ABSTRACTS In addition these diagnosis tools need to take in account the current variable status of the countries: what are the confounding hepatitis cause (HBV, HCV, HEV, HAV) that cannot be prevent with the very same strategies. Moreover, malaria endemic countries that induce a lot of acute liver failure may mask part of the initial symptoms that patients or physician forgot to notice. 38 Programme & Abstracts Liver Disease in Resource Limited Settings

39 O2 VIRAL HEPATITIS: WHAT ARE THE SKILLS GAPS IN RLS Philip Bruggmann* Internal Medicine, Arud Centres for Addiction Medicine, Zurich, Zürich, Switzerland Corresponding author s p.bruggmann@arud-zh.ch Restrictive drug policy and law enforcement are key drivers of the HCV epidemic among PWID, in even greater magnitude than of HIV, as HCV is more contagious and 3.5 times more prevalent. Successful HCV prevention strategies combine high coverage of harm reduction measures with HCV treatment provision at the right scale. Worldwide 2 needles/syringes are distributed per month to individual people who inject drugs, 8 out 00 have access to opioid substitution therapy. Incarceration is a main risk factor for HCV transmission due to high HCV prevalence in custody, lack of effective prevention measures and very low to non-existing treatment provision. People who inject drugs are often not able to adhere to the highly structured secondary or tertiary care settings, where HCV assessment and treatment is usually provided. Furthermore many physicians are reluctant to treat PWID driven by unfounded concerns of adherence, medical comorbidities and the risk of re-infection. The setting of HCV clinics is normally not adapted to the special, mainly psychosocial needs of the polymorbid population of PWID. One of the major obstacles to HCV care for PWID in resource limited regions is the lack of treatment settings that are suitably adapted for the needs of this vulnerable population. Nevertheless, HCV treatment has been delivered successfully to PWID through various multidisciplinary models such as community based clinics, substance abuse treatment clinics, and specialized hospital-based clinics. Additional innovative models include directly observed therapy and peer-based models. A high level of acceptance of the individual life circumstances of PWID rather than rigid exclusion criteria will determine the level of success of any model of HCV management. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS HCV infection disproportionally affects people who inject drugs (PWID) and his highly prevalent in this risk group. Globally, 67% of PWID are HCV positive. Awareness is low among policy makers, political leadership and general public, particularly in the resource limited regions most affected by the HCV epidemic among PWID. Despite this, the public health threat is considerable and will manifest itself in the next five years. Overall, only 0 50% of all PWID worldwide receive HCV testing, less than 0% have access to assessment and treatment of the disease, despite the evidence that treatment is effective. 2 million people who inject drugs globally need treatment immediately due to severe liver disease.

40 SPEAKERS ABSTRACTS Because PWID will be responsible for a relevant part of the future HCV disease burden in resource limited settings, improved access to care for this population must be a priority in the public health efforts of the next few years. Even with affordable prices, the impact of highly potent and well-tolerated interferon-free HCV treatment regimens will remain negligible as long as access to therapy cannot be expanded to the most affected risk groups. In order for the roll-out of these new IFN-free regimens to control HCV among PWID, drastic changes and the breaking of some taboos will be required. 40 Programme & Abstracts Liver Disease in Resource Limited Settings

41 O6 A HEALTH-SYSTEMS APPROACH TO SCALING-UP HEPATITIS TREATMENT Stefan Wiktor* Global Hepatitis Programme,World Health Organization, Geneve, Switzerland Corresponding author s wiktors@who.int SPEAKERS ABSTRACTS Viral hepatitis is a global public-health problem causing an estimated.45 million annual deaths. A total of 240 million people are estimated to be living with chronic hepatitis B (HCB), and between million with chronic hepatitis C infection (HCV). Both HBV and HCV are treatable, but very few people with hepatitis globally have access to testing and treatment. To increase this number, a health systems approach is needed that addresses leadership and governance, health information systems, human resources, health financing, appropriate medicines, diagnostics, and service delivery. EASL Monothematic Conference Bucharest, Romania May 29-30, 205 4

42 O7 STANDARD TREATMENT OF HEPATITIS B AND DELTA Heiner Wedemeyer* Gastroenterology, hepatology and Endocrinology, Hannover Medical School, Hannover, Germany Corresponding author s hardtke.svenja@mh-hannover.de Treatment of hepatitis B infections is well established but treatment of hepatitis delta remains a major challenge with very limited options to induce cure from HDV infection. Hepatitis B: Over the last years, international and national guidelines were published defining distinct treatment algorithms for different patient populations. Two different treatment concepts are available: One the one hand pegylated interferon alpha (peg IFN alpha) allowing finite treatment with the aim to induce sustained immune control of HBV infection, on the other hand inhibitors of the HBV polymerase which are the nucleoside analogues and the nucleotide analogues. SPEAKERS ABSTRACTS But there are open questions which still need to be resolved: eg. which patients require long-term antiviral therapy? Modern treatment of hepatitis B should be personalized as there is no one size fits all approach for all patients with hepatitis B. Not every HBsAg-positive individual requires antiviral intervention and the decision to initiate treatment depends on the risk to develop liver-related complications (hepatic decompensation, HCC) as well as on social and legal aspects for a patient suffering from an infectious disease. Alternative treatment conceptsare currently in early clinical development, include immunotherapies such as alternative interferons (e.g. lambda-interferon), toll-like-receptor agonists or therapeutic vaccinations. In addition, different steps in the HBV life-cycle can be targeted by antiviral compounds. 42 Programme & Abstracts Liver Disease in Resource Limited Settings

43 Hepatitis delta: Suppression of HDV RNA replication is the primary goal of treatment of hepatitis delta which is usually associated with normalization of liver enzymes and histological improvement of liver disease. Ideally, antiviral therapy induces serological cure from hepatitis B defined by HBsAg loss and development of anti-hbs antibodies, simultaneously also leading to recovery from HDV infection. The only available treatment option for hepatitis delta is administration of (pegylated-) interferon alfa. Approximately 25-40% of patients become HDV RNA negative during 4896 weeks of therapy(results of the HIDIT-2 trial) however, HDV remains undetectable during further long-term follow-up only in a small proportion of patients and late relapses may occur even 5 years after the end of treatment as we recently demonstrated for patients treated in the HIDIT- study. SPEAKERS ABSTRACTS Possible future treatment options include novel therapies leading to clearance of HBsAg. In addition, post-translational modification steps of hepatitis delta antigens including methylation, acetylation, phosphorylation and isoprenylation are potential therapeutic targets. Clinical trials are ongoing investigating prenylation inhibitors and entry inhibitors to treat HDV infection. EASL Monothematic Conference Bucharest, Romania May 29-30,

44 O8 STANDARD TREATMENT OF HEPATITIS C Alessio M Aghemo* UO Gastroenterologia ed Epatologia, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy SPEAKERS ABSTRACTS Corresponding author s alessio.aghemo@policlinico.mi.it Treatment of chronic Hepatitis C (HCV) is aimed at achieving a sustained virological response (SVR), which is defined by HCV RNA undetectability 2 weeks following treatment discontinuation. Although an SVR is a surrogate marker of cure, several studies published in the last years have convincingly shown that the achievement of an SVR benefits all patients with chronic HCV infection as it improves survival, reduces the development of complications of cirrhosis and the development of extra-hepatic manifestations directly linked to HCV infection. For this reason the EASL clinical practice guidelines and treatment recommendations for HCV suggest to consider all patients with chronic hepatitis C for treatment. In the past this sentence was unfortunately unrealistic, as treatment was based on the combination of Interferon and Ribavirin which was not only poorly effective in patients with advanced fibrosis but also associated with severe side effects that de facto limited its applicability only to highly selected patients populations. The development of directly acting antivirals (DAA) targeting key steps in the HCV lifecycle has radically improved the tolerability and the efficacy of treatment regimens for chronic Hepatitis C. Through combination of drugs targeting the NS3 protease protein, the NS5A protein or the NS5B polymerase, SVR rates in the 90-95% range can be achieved across all HCV genotypes even in the most difficult to cure patients, those with advanced fibrosis/cirrhosis. Ribavirin is still an essential player in patients with cirrhosis as it increases efficacy rates while also allowing for shorter treatment durations, but is likely to disappear in the near future when 2nd generation DAAs will enter the market. Future studies with combination of 3-4 DAAs are aimed at shortening treatment duration which is now set at 2 weeks in most cases. This however does not seem a major breakthrough as the biggest challenge we are now facing all over Europe and Worldwide is increasing access to therapy for patients with HCV infection. To reach this endpoint several barriers need to be swept away, it is indeed essential to increase diagnosis rate but most importantly to reduce drug pricing so that all HCV patients can benefit from this treatment revolution. Disclosure of Interest: A. M. Aghemo: Consultant/ Advisor: Gilead Sciences, AbbVie, Janssen, MSD, Sponsored Lectures: National or International: Gilead Sciences, MSD, AbbVie, Janssen, BMS 44 Programme & Abstracts Liver Disease in Resource Limited Settings

45 O9 DRUG ABUSE AND CHRONIC VIRAL HEPATITIS IN RESOURCE LIMITED SETTINGS: IMPACT OF HCV TREATMENT FOR PEOPLE WHO INJECT DRUGS Natasha Martin*, 2 Division of Global Public Health, University of California San Diego, San Diego, United States, 2 Social and Community Medicine, University of Bristol, Bristol, United Kingdom Corresponding author s natasha.martin@bristol.ac.uk In many (but not all) resource limited settings, injecting drug use is a key mode of HCV transmission. Traditional harm reduction interventions such as opiate substitution therapy and needle and syringe programmes have been shown to reduce and individual s injecting risk and prevent HCV transmission. Despite the availability of increasingly effective HCV antiviral treatment, HCV treatment rates among PWID are low even in high income settings. This is despite available evidence indicating that HCV treatment outcomes among PWID are similar to the non-injecting population and reinfection rates are low. Additionally, modeling studies have suggested that modest levels of HCV antiviral treatment for PWID could prevent onwards transmission and dramatically reduce HCV incidence and chronic prevalence among PWID. The impact of HCV prevention interventions among PWID on the country-level HCV epidemic, particularly in resource limited settings which may also have other modes of transmission is unclear. I will discuss our recent modeling case studies which have explored what is needed to control the HCV epidemic at a country-level in settings with various levels of injecting drug use. Disclosure of Interest: N. Martin: Grant/Research Support: Gilead Sciences unrelated to this work, Sponsored Lectures: National or International: Gilead, AbbVie, Janssen EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS Worldwide, it is estimated that 6 million (range -2 million) people injected drugs in Injection drug use is an efficient mode of blood borne virus transmission, especially hepatitis C virus (HCV) and hepatitis B virus (HBV). Globally, >60% of people who inject drugs (PWID) are anti-hcv positive, with >80% infected in many settings. It has been estimated that 0 million people who inject drugs (PWID) are anti-hcv positive, of which about 3 million are in China and Russia alone. Additionally, over 2 million HCV-positive PWID live in eastern Europe. Importantly, these estimates only include those who have injected in the past year; the burden of viral hepatitis due to drug use (past and present) is likely to be much greater. By contrast, far fewer PWID worldwide are infected with HBV and the highest prevalences HBV among PWID are found in countries with high rates of HBV endemicity.

46 O20 HEPATITIS B AND DELTA Cihan Yurdaydin* Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey SPEAKERS ABSTRACTS Corresponding author s cihan.yurdaydin@medicine.ankara.edu.tr Delta hepatitis is the less frequently encountered but most severe form of viral hepatitis. Acute delta hepatitis as a result of co-infection with hepatitis B and hepatitis delta is rare but may lead to fulminant hepatitis and no therapy exists for this form. Chronic delta hepatitis (CDH) mostly develops as a result of superinfection of an HBsAg carrier with hepatitis delta where hepatitis D virus (HDV) is in general the dominant virus. Around 5% of the HBsAg carriers in the world are infected by HDV. Implementation of hepatitis B vaccination on a global scale has led to a decline of the incidence of hepatitis D in southern Europe as well as in the Far East after 990. However, hot spots of HDV infection still exists which appear to export the disease to areas of the world where both HBV and HDV are infrequent. These hot spots include Romania, Albania and Turkey in Europe, central Asian countries of the former Soviet Union, Pakistan, Mongolia, countries in Sub-Saharan Africa, the Amazon Basin in Brasil and Greenland. HDV is not homogenously distributed in these areas and is more frequently encountered in areas of low socioeconomic class. On the other hand, HDV infection has received Orphan Disease designation (< 5 in 0 000) in the US and within European Union countries. However, in these countries with low HDV prevalence, HDV continues to be encountered as a consequence of migration and because of its severity poses a health problem. The fact that no evidence based rules for treating CDH exist is a serious public health threat in HDV endemic and mostly resource limited countries. Overall, treatment duration needs to be individualized based on virologic response at end of treatment or end of follow-up which demands increased responsibility and knowledge by the treating physician. On treatment stopping rules based on viral kinetics during interferon therapy are well established for chronic hepatitis B and C but unfortunately not for CDH. Patients who after EOT relapse need be considered as interferon responder patients as such patients potentially could benefit from prolonged therapy. It is critical to identify those patients who will not respond to treatment to avoid unnecessary and costly treatment with cumbersome side effects. Patients who did not have a virologic response (VR) at end of treatment do not suit such a non-response criteria as it appears that patients without VR at end of treatment may still develop VR at post-treatment week 24. Thus, any stopping rule based on end of treatment viral non-response can be misleading. Effective treatment is important as it may decrease liver related complications such as decompensation or liver related mortality. 46 Programme & Abstracts Liver Disease in Resource Limited Settings

47 O2 SPECIAL ISSUE IN RESOURCE LIMITED SETTINGS: HEPATITIS C Mark Thursz* Medicine, Imperial College, London, United Kingdom Corresponding author s m.thursz@imperial.ac.uk Treatment of HCV infection requires access to sophisticated and frequently expensive diagnostics including molecular virology and assessment of liver fibrosis. Many resource constrained countries have only one or two laboratories capable of measuring viral load and genotype which are mainly provided for the private sector. Viral load assays which might cost 50 Euros would typically be charged at 200 Euros in sub-saharan Africa. Furthermore the absence of virological expertise in some regions prevents the expansion of laboratory facilities. New point of care diagnostics with automated sample processing may soon provide a solution to this problem. However, validation of the assays by WHO is still awaited. There are many barriers to the provision of appropriate medications to treat HCV. Whilst most of us are aware of the cost issues there are substantial problems surrounding the licensing of medications and the regulation of generic drug supplies to avoid parallel importation. Generic sofosbuvir is already available in some countries and negotiation is proceeding to provide access to the Abbvie regimen. Even at generic prices HCV antivirals will be beyond the reach of many infected patients. Apart from Egypt very few countries in resource limited settings have government backed viral hepatitis programmes. Furthermore, unlike HIV, TB and malaria there is no Global Fund to pay for the medications. Lobbying efforts by Medicins Sans Frontiers and World Hepatitis Alliance may remedy this situation in coming years. Disclosure of Interest: M. Thursz: Grant/Research Support: Gilead, Consultant/ Advisor: Gilead, BMS, Abbvie, MSD, Sponsored Lectures: National or International: Gilead, BMS, Abbvie EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS WHO estimate that around 70 million people worldwide are chronically infection with Hepatitis C and the majority of those people live in low or low-middle income countries. In resource limited settings the transmission routes for HCV infection differ from those encountered in western countries in that intravenous drug use is a relatively uncommon route of infection whereas iatrogenic and nosocomial transmission are common. This is best exemplified by Egypt where public health campaigns to treat schistosomiasis with tartar emetic lead to a high prevalence of infection and the reuse of hypodermic needles and sutures has sustained a high incidence of infection. Efforts to control the ongoing transmission of infection have only been partially successful.

48 O22 HIV COINFECTION Patrick Ingiliz* Medical Center for Infectious Diseases, MEDICAL CENTER FOR INFECTIOUS DISEASES, Berlin, Germany Corresponding author s p_ingiliz@web.de SPEAKERS ABSTRACTS Since the beginning of the epidemic about 75 million [63 million 89 million] individuals have been infected with human immunodeficiency virus (HIV) and mainly in resourcelimited countries. To date, of the 35 million people, more than 30 million are living in Africa and Asia. Owing to their shared routes of transmission, HIV and viral hepatitis co-infection is common, and affects around 6 million individuals globally according to most recent WHO estimations. The tremendous progress made in the treatment of HIV infection in the past 30 years allowed liver disease, and specifically HCV infection, to arise as a main contributor to morbidity and mortality in the HIV-infected population in the Western world. But also in low- and middle income countries, around 9.7 million people living with HIV had access to antiretroviral therapy in 202, representing 6% of people eligible for treatment under the 200 WHO guidelines, and 34% of people eligible under the 203 WHO guidelines. Consecutively, viral hepatitis coinfection represents an emerging major health concern also in resource-limited settings. HIV coinfection leads to a decreased specific immune response, and more recently, it has been shown that HIV can induce pro-fibrogenic pathways itself. Coinfected subjects suffer from accelerated fibrosis progression with an increased risk of hepatic decompensation, and hepatocellular carcinoma. In several cohort studies the risk of liver-related mortality has been found to be 2-3 times higher in HIV/HBV-coinfected patients than in HIV-monoinfected patients. The effect of HBV on HIV disease progression is however less clear. Treatment is therefore recommended mainly in line with indications for antiretroviral therapy, and is based on dually active agents such as tenofovir. HIV-HCV coinfection leads to a more aggressive course of the disease compared to HCV monoinfected counterparts. Effective antiretroviral treatment may decrease this effect. Therefore, HIV treatment is recommended for HIV-HCV coinfected patients, usually at a CD4 cell count below 500/mm3. 48 Programme & Abstracts Liver Disease in Resource Limited Settings

49 HCV treatment is recommended for every coinfected individual, and has historically been based on pegylated interferon. Multiple studies have shown a beneficial impact of an HCV cure on liver-related and overall survival. In coinfected patients, response rates to pegylated interferon and ribavirin therapy were however much lower than in HCV moninfected individuals. Moreover, the storage of the drugs, the management of side effects, and the cost for treatment, limit the use of interferonbased treatments in resource-limited settings. But the development of directly acting agents against hepatitis C such as sofosbuvir has dramatically changed the landscape. Besides high response rates, these new oral treatments are very well tolerated. In HIV-HCV coinfected subjects, cure rates are now equal to monoinfected subjects, international guidelines are now similar in HIV/HCV coinfected subjects and the challenge lies mainly in the management of drug-drug interactions. Coinfected patients represent a group of patients with an urgent need for treatment as they have a more aggressive course of liver disease. Tenofovir should be accessible for all patients with HBV coinfection. As a lesson to be learned from the HIV epidemic, new HCV compounds should be provided in all parts of the world. As a first step, the World Health Organization has added just recently 5 new HCV compounds on the List of Essential Medicines. SPEAKERS ABSTRACTS Disclosure of Interest: P. Ingiliz: Consultant/ Advisor: Gilead, Abbvie, Sponsored Lectures: National or International: Gilead, Abbvie, BMS, MSD, Pfizer, Janssen-Cilag EASL Monothematic Conference Bucharest, Romania May 29-30,

50 O26 PROVIDING HEPATITIS TESTING IN MOZAMBIQUE AND SEVERAL RESOURCE LIMITED SETTINGS: THE MSF EXPERIENCE. Isabelle Meyer-Andrieux*, Krzysztof Herboczek2, Dmytro Donchuk 3, Helen Bygrave 3, Anita Mesic 2, Linn Htet 4, Marcelo Fernandez 4, Lucas Molfino 5, Javier Goiri, Susanna Cristofani Médecins Sans Frontières, Geneva, Switzerland, 2Médecins Sans Frontières, Amsterdam, Netherlands, 3Médecins Sans Frontières, Bruxelles, Belgium, 4Médecins Sans Frontières, Yangon, Burma, 5Médecins Sans Frontières, Maputo, Mozambique Corresponding author s isabelle.andrieux-meyer@geneva.msf.org SPEAKERS ABSTRACTS Objective: Little is known about the magnitude of viral hepatitis B (HBV) and viral hepatitis C (HCV) disease burden in resource limited settings.the objective of this study is to estimate the prevalence of the HBV and HCV mono-infection and co-infection with HIV in several MSF projects, and collect information to design adequate package of care and treatment. Methods: Cross sectional surveys are or have been conducted to estimate the prevalence of HBV and/or HCV in MSF HIV cohorts in India, Kenya, Mozambique, and Myanmar. The HIV-HCV cascade of screening in Dawei Myanmar is detailed, including the baseline characteristics of the studied patients. HBV and HCV screening activities are also reported in prisons in Ukraine, slums in Pakistan, prenatal & delivery care in Mozambique, and among blood donors in the DRC. The following screening tests have been used: HCV rapid antibody tests: Oraquick, Orasure, or HCV spot ; and Determine HBsAg for HBV screening.the HIV-HCV screening cascade Dawei, Myanmar: among the 300 HIV-HCV co-infected patients identified using HCV Oraquick, 8.7% are male, mean CD4 count is 370 /mm², HIV viral load is 0.5, including 22.5% with an APRI >.0 and 4.6% with APRI>.5. Patients with a positive Oraquick and an APRI > 0.5 are prioritized for HCV viral load and genotyping. Among the first 37 samples sent for genotyping and viral load, 8 genotypes 3, and 7 genotypes were identified; 2 samples only had no active HCV infection. Discussion: the prevalence of HBV and HCV mono and co-infections in the settings surveyed reveal an unaddressed public health problem. More efforts are needed to better understand the true burden of HBV and HCV epidemics in resource limited settings, and the risk factors, to design adequate package of care and treatment. APRI combined to HCV serology is helpful to identify the most at risk of advanced liver disease, and prioritize them for HCV viral load, genotyping and treatment. 50 Programme & Abstracts Liver Disease in Resource Limited Settings

51 The main access challenges identified for people living with HBV are: scaling-up access to HBV screening and liver laboratory monitoring, registration of tenofovir and entecavir for the HBV mono-infection indication in resource limited settings, availability of affordable generics of tenofovir or entecavir; implementation of HBV birth dose immunization. The main access challenges identified for HCV patients are: a complex and expensive screening & diagnostic procedure, limited capacity for liver fibrosis assessment, lack of trained staff, slow registration of DAAs in low and middle income countries, absence of national program, no availability of WHO pre-qualified generics of DAAs at affordable price yet, drug monopoly situation and prohibitive prices, weak civil society mobilization. Conclusion: Scaling-up access to screening/diagnostic and generic treatments at affordable price for people living with HBV and HCV infections in resource limited settings remain major barriers for mono and co-infected patients. SPEAKERS ABSTRACTS Figure 2: EASL Monothematic Conference Bucharest, Romania May 29-30, 205 5

52 O27 HEPATITIS C IN RESOURCE LIMITED SETTING: IMPLEMENTATION PROJECTS IN IDVU S Julie Bouscaillou*, Niklas Luhmann International Operations Division, Médecins du Monde, Paris, France Corresponding author s julie.bouscaillou@medecinsdumonde.net People who inject drugs (PWID) carry a growing burden of the HCV epidemic, with 8 million of PWID among the millions of anti-hcv antibody carriers worldwide in High Income countries, around 90% of new hepatitis C infections are attributed to injection drug use. More than half of the infected PWID reside in Low and Middle Income Countries (LMICs), especially in East/Southeast Asia and Eastern Europe where respectively 26% and 23% of them live. SPEAKERS ABSTRACTS Access to HCV treatment remains very limited in LMICs, and PWID are even less likely to seek and receive HCV prevention and care, due to drug use criminalization and concerns of health authorities and professionals about poor adherence and reinfection. Only 4% of PWID needing a treatment for HIV actually have access to ART, although this therapy is now widely available. While the recent development of simple, tolerable and highly effective directly acting antiviral (DAA) therapies may become a significant game changer in HCV treatment access around the world, PWID may continue to be excluded from treatment programs. HCV treatment programs targeting PWID in LMICs is feasible and would be effective, provided that specific measures are taken to overcome provider/facility and policy barriers. Integrating HCV care into harm reduction services could enhance adherence through strong peer support, and reduce risk takings and reinfections.within these programs, advocacy efforts demanding supportive legal environment for PWID and universal access to affordable diagnostics and treatment should be sustained. As a case study, we present the interventions developed by Médecins du Monde to facilitating the access of PWID to the national HCV eradication program in Georgia. 52 Programme & Abstracts Liver Disease in Resource Limited Settings

53 O29 TREATING HCV WITH INTERFERON-FREE REGIMEN IN CAMEROON, CÔTE D IVOIRE AND SENEGAL : THE ANRS 236 TAC TRIAL Karine Lacombe* Infectious Diseases, St Antoine Hospital, Inserm - Sorbonnes Université, Paris, France Corresponding author s karine.lacombe2@aphp.fr Access to HCV treatment in resource-limited countries has always been a challenge due to technical and financial constraints. Because of the low rate of response to peg-interferonbased therapy, particularly in the most difficult-to-treat patients (genotypes and 4, HIV co-infected), the complexity of managing side effects, difficult storage conditions, the high drug cost and so subsidy of HCV treatment, implementing large-scale use of peginterferon-based therapy in resource-limited countries is almost unachievable. However, the recent advent of direct antiviral agents targeting HCV protease or polymerase activities has triggered a major shift in the treatment of HCV genotype, 2 and 4. Shorter courses of treatment associated with a higher rate of sustained virological response and a lower rate of side effects make DAA appealing candidates for HCV treatment in resource-limited settings. Results from trials with Peg-interferon-free regimens based on 3 to 6 months of sofosbuvir + ribavirin in HCV mono-infected patients (such as those from Egypt) have been promising and make this combination an good candidate for resources-limited countries. However, its results may not fully apply to HCV in the Sub-Saharan Africa context where other routes of transmission are more commonly reported, population (genetic and anthropometric) characteristics generally associated with treatment response are different, local constraints are not comparable, and its epidemic closely overlaps that of HIV. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS Chronic hepatitis C is increasingly identified as an emerging chronic condition leading to a greater health burden in resource-limited countries. Global prevalence is estimated to reach up to 6% in Central Africa, while prevalence rates of 2-3% have been recorded in West Africa, with genotypes (G), Genotype 2 (G2) and 4 (G4) (considered as the most difficult-to-treat) and 2 being the most prevalent genotypes. Once considered as a hidden epidemic, chronic hepatitis C virus (HCV) infection is now more likely to be diagnosed. Its spread is linked to increased drug-use in urban areas of Eastern, Central and West Africa and to nosocomial transmission.

54 Moreover, evidence-based medicine data are regularly required by WHO and local governments, whereby recommendations on HCV care and treatment are adapted to SubSaharan settings. We have therefore set up a trial for evaluating the feasibility, the tolerability and the efficacy of a 2- or 24-week course of sofosbuvir and ribavirin for the treatment of chronic hepatitis C genotype, 2 and 4, in HCV treatment-naïve, HIV negative and positive patients from 3 sub-saharan African countries, Senegal, Côte d Ivoire and Cameroun. A unique consortium involving clinicians, virologists, researchers and advocacy carriers has been set up to conduct this trial. This consortium will also work on the establishment of an African network including other French- but also English-speaking countries that will organize training on HCV infection and advocate for a better and broader access to HCV treatment in resources-limited countries. Finally, this network will also aim at developing research on HCV management and contributing to the development of treatment strategies adapted to the local constraints and populations of resources-limited countries. SPEAKERS ABSTRACTS Disclosure of Interest: K. Lacombe: Grant/Research Support: Gilead 54 Programme & Abstracts Liver Disease in Resource Limited Settings

55 O30 LIVER TRANSPLANTATION PROGRAMS IN EASTERN EUROPE: POLAND Jerzy Jaroszewicz* Department of Infectious Diseases and Hepatology, Medical University in Bialystok, Bialystok, Poland Liver transplantation program is relatively young in Poland. First successful liver transplantation (LTx) in a child was performed in 990 and in an adult in 994 both in Warsaw. Since mid-nineties of XX-th century the number of liver transplantations in Poland is systematically increasing and exceeded 3000 in 204. Liver transplantations in Poland are performed in adults in 4 centers and in children in one. In liver transplants from cadaveric donors and 30 from living donors were performed. In 204 average waiting time for elective LTx was 6 months (2-9 months) and 3 days for emergency one (2-6 days). The main indication for adult LTx was infection with HCV (20%), alcoholic liver disease (2%), autoimmune hepatitis (8%) and infection with HBV (6%). In children main indication was biliary atresia (4%). Overall 5 and 0 years patients and graft survival (all centers, all indications) were 74%, 65% and 70%, 59%, respectively. Data from leading LTx center for adults in Poland in Warsaw including 473 liver transplants performed since 2000 show that overall mortality during last 3 years was 20,7% (98 deaths). Overall 5 and 0 year survival in a group of 2 patients transplanted for HCV cirrhosis were 85,9% and 84,3%, respectively. In conclusion, although liver transplant program in Poland is in good progress the number of performed LTx is still not sufficient enough. Results of LTx vary depending on the experience of transplant center. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS Corresponding author s jerzy.jr@gmail.com

56 O3 LIVER TRANSPLANTATION PROGRAMS IN EASTERN EUROPE: ROMANIA Irinel Popescu* and Fundeni Clinical Institute - Center of General Surgery and Liver Transplantation Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania Corresponding author s irinel.popescu220@gmail.com Background. Liver transplantation (LT) has become an established treatment for endstage liver disease, with more than procedures yearly worldwide. The aim of this study was to analyze the outcome after 5 years of LT in Romania. SPEAKERS ABSTRACTS Methods. Between April 2000 and April 205, 639 pts received 669 LTs in Romania. Male/female ratio was 377/262, while adult/pediatric ratio was 58/58, with a mean age of 45 years (range 7 months 68 years). Main LT indications were HBV-related cirrhosis (75 pts; 27.4%), hepatocellular carcinoma (28 pts; 20%), and HCV-related cirrhosis (6 pts; 8.%). The methods to increase the donor pool and the number of LTs were analyzed. Waiting time and indications for LT, patient and donor demographics, surgical procedures, and short and long-term outcomes were also analyzed. Results. Deceased donor LT was performed in pts: whole LT in 499 pts (78.%), split LT in 7 pts (2.6%), reduced LT in 5 pts (0.8%), and domino LT in 2 pts (0.3%). Living donor LT was performed in 6 pts (8.%); 2 were dual living donor LTs. Perioperative mortality was 8% (5 pts), while retransplantation rate was 4.7% (30 pts). Long-term overall -, 3-, and 5-year estimated survival rates for patients were 88.8%, 82.5%, and 79.2%, respectively, while for transplanted grafts were 77.9, 7.6, and 68.8%, respectively. Median waiting time for LT decreased significantly over time: from 07, 99, 5, and 45 months to 28, 8, 34, and 20 months in case of 0I, AII, BIII, and ABIV group pts, respectively. One-year overall mortality on waiting list decreased significantly over time from 3.4% to.8%. Conclusions. The liver transplantation program in Romania constantly increased over time, leading to less time and lower mortality rate on the waiting list. 56 Programme & Abstracts Liver Disease in Resource Limited Settings

57 O33 LIVER TRANSPLANTATION PROGRAM IN KAZAKHSTAN Alexander Nersesov*, Nariman Sadykov2, Daniyar Toksanbayev2, Almagul Jumabayeva, Maxat Doskhanov2, Serik Zharikov3 Gastroenterology and Hepatology, National Research Institute of Cardiology and Internal Diseases, 2 Hepatopancreatobiliary Surgery and Liver Transplantation, Syzganov s National Research Center of Surgery, Almaty, 3National Coordination Center of Transplantation, Astana, Kazakhstan Liver diseases in the Republic of Kazakhstan are of increasing interest. The main causes of these are viral hepatitis. In a whole, country is characterized by low-to-moderate prevalence (depending on population group) of anti-hcv and HBsAg carriages, which consist as lower as 2% in blood donors and pregnant women and more than 50% in HIV-infected persons. According to single center data (n=378), the main liver cirrhosis etiology are HCV (35.4%), HDV (23.5%) and HBV (8.3%). Since 20, screening for HBsAg, anti-hdv and antihcv and treatment reimbursement program, and since 204 screening for hepatocellular carcinoma were initiated on a governmental level. Liver transplantation (LT) program was launched in 20. To the moment 73 LTs have been performed in 6 national centers and regional hospitals, in collaboration with leading World s transplant centers. 60 LTs were done from living donors and 3 from deceased donors, 7 LTs for adult recipients and 2 for children. While planning living donor LT, graft type selection is typically based on volumetry. An estimated graft volume, as well as the remnant liver volume, are defined to be not less than 35%. According to single center data (n=24), predominant liver diseases etiology in transplanted patients was viral hepatitis (HDV 37.5%; HCV 6.7%; HBV 8.3%; HDV+HCV 4.2%); autoimmune hepatitis constituted 6.7%; primary biliary cirrhosis 4.2%; secondary biliary cirrhosis 4.2%; cryptogenic cirrhosis 8.3%. Since beginning of the LT program, 62 transplanted patients are alive, and patients died in their early post-operative period mainly because of hepatic failure. There were no any mortality in living donors; 3 (4.9%) living donors have had post-operative complications, such as bile leakage, biliary obstruction and bleeding, which were successfully cured. While establishing LT program in Kazakhstan, we have faced to several difficulties of different origin. The medical/institutional ones included absence of National (Unified) waiting list; significant lack of donor organs; lack of qualified transplant teams and equipped centers. Social aspects were connected mostly with population mentality (denial for organs harvesting by potential deceased donors families). These problems are solving graduately at the state level, including viral hepatitis Registry development, full budgetary coverage of LT and immunosuppressive therapy, training abroad etc. Also, great attention is paid for social mobilization on transplantation support. EASL Monothematic Conference Bucharest, Romania May 29-30, SPEAKERS ABSTRACTS Corresponding author s alexander.nersesov@gmail.com

58 CO-ORGANISED BY AASLD AUTOIMMUNE HEPATITIS SEPTEMBER 3-5, 205 LONDON, UNITED KINGDOM ABSTRACT SUBMISSION DEADLINE: JUNE 6, 205 Scientific Organising Committee Prof. E. Krawitt, Burlington, USA Prof. M. Manns, Hannover, Germany Prof. D. Vergani, London, UK Prof. J. Vierling, Houston, USA For the scientific programme, online applications, and additional information please visit: EASL thanks its Premium Sponsors for their generous contributions and support.

59 POSTERS ABSTRACTS

60 P0 PRIORITIZATION OF SCREENING PROGRAMS OF HCC AND LIVER FIBROSIS IN EGYPTIAN PATIENTS WITH CHRONIC HEPATITIS USING DATA MINING TECHNIQUES Abubakr Awad*, Dalia Omran2, Mahasen Mabrouk2, Ashraf Omar2, Hesham Elmaghzangy2 Computer Science, Faculty of Computers and Information - Cairo University, Giza, 2Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt Corresponding author s bakr.awad@gmail.com Introduction: Egypt having the highest prevalence worldwide, 0% (9 million) were found to have positive HCV viraemia that may progress in 20% of patients to cirrhosis or even Hepatocellular carcinoma (HCC). Early detection of HCC dictates the therapeutic choice, also patients with (F3-F4) are considered a priority group for treatment. Screening programs of HCC or liver significant fibrosis for this huge number of patients may not be always available in countries with limited resources. Aims: Reducing the cost of screening programs of HCC and liver fibrosis using data mining techniques for prioritizing Egyptian patients with chronic hepatitis C. POSTERS ABSTRACTS Material and Methods: This cross-sectional study included cohort of 4963 chronic HCV patients who were evaluated for anti-viral therapy at Cairo-Fatemic Hospital in addition to 35 HCC patients from Using the data mining analysis, we constructed decision tree learning algorithm (C4.5) to predict HCC, and to diagnose significant fibrosis (F3-F4). Results: Decision tree algorithm was able to diagnose minimal fibrosis (<F3) and significant fibrosis (F3-F4) with sensitivity 80.% and specificity 75.2%, and HCC with sensitivity 83.5% and specificity 83.3% using only routine data. Out of 20 attributes, the decisiontree models showed that serum level of AFP at an optimal cutoff value of 5.5 ng/ml was selected as the best predictor of the degree of fibrosis (Fig. ). While the best predictor of HCC was serum level of AFP with an optimal cutoff value of 50.3 ng/ml (Fig. 2). These findings were further confirmed using multivariate logistic regression analysis. 60 Programme & Abstracts Liver Disease in Resource Limited Settings

61 Conslusions: Data mining analysis explores data to discover hidden patterns, trends and enables the development of models to predict HCC and liver fibrosis utilizing simple variables that have the prospective to support clinical decisions, without imposing extra costs for additional examinations. Only patients with high probability will be further subjected to more expensive procedures as triphasic CT, fibroscan. Figure or Table: n = 35/HCC (42.86%) AFP n = 4963/F3-F4 (20.05%) 50.3 AFP < n = 85 HCC (20.54%) n = 3479/F3-F4 (2.72%) n = 484/F3-F4 (37.23%) Platelets Platelets <6.5 n = 330 F3-F4 (30.86%) 6.5 n = 2929 F3-F4 (9.3%) <82.5 < n = 383 F3-F4 (56.38%) >64 n = 37/HCC (43.04%) Sex n = 788 F3-F4 (26.64%) n = 33 F3-F4 (40.44%) n = 30/HCC (74.6%) AST n = 696/F3-F4 (49.2%) AST n = 93 HCC (86.98%) = Male = Female n = HCC (7.05%) n = 26/HCC (53.94%) Aseted = NO = YES n = 0 HCC (33.2%) n = 6 HCC (66.55%) Fig.2 (Prediction of HCC) POSTERS ABSTRACTS Fig. (Prediction of Advanced Fibrosis (F3-F4)) >50.3 EASL Monothematic Conference Bucharest, Romania May 29-30, 205 6

62 P02 LIVER TRANSPLANTATION EXPERIENCE IN REPUBLIC OF MOLDOVA: ISSUES AND ACHIEVEMENTS Adrian Hotineanu, Vadim Hotineanu, Victor Cojocaru2, Elena Moraru 2, Vlada Dumbrava3, Natalia Taran4, Angela Peltec* 3, Grigore Ivancov5, Sergiu Burgoci, Sergiu Ursu2 Department of Surgery N2, 2Department of Anaesthesiology and Intensive Care II, 3Clinic of Gastroenterology, Department of Internal Medicine, 4Scientific Laboratory of Gastroenterology, State University of Medicine and Pharmacy N.Testemitanu, 5Central Republic Hospital, Chisinau, Republic of Moldova Corresponding author s natalita_taran@yahoo.com Aims: In 202 the mortality through chronic hepatitis and hepatic cirrhosis (HC) in RM s population was in continuous growth cases/ population, more in 33,53 of HC cases/ population. POSTERS ABSTRACTS Material and Methods: The initiation of Liver Transplant (LT) in RM begins in 203. The waiting list includes 77 patients, with average age of 30,2±2,04 years, the main indication being viral cirrhosis VHC - (4,28%), VHD - 55 (7,42%). 28 patients (36.4%), from the list, died. We present 2 cases of our LT experience ( ), of which 7 LT recipients were performed from living donors, 5 - LT from a whole liver of a donor in brain death. In our records there are 0 recipients and 7 donors. The average age of donors being 42,33±4,3 years, male/female ratio of - 5/2; average age of recipients is 45,83±3,0 years, male/female ratio of 7/5. Results: The transplant group includes: 2 patients transplanted for HC VHD and HCC, 2 for HC VHC, 2- HC VHB CH 2, 5 - HC VHD, - primary biliary cirrhosis. The immediate postoperative survival is at 80% (0 patients). The immediate postoperative morbidity is at 6,67% (2 of 2 patients): ) intracerebral hemorrhage, 2) - acute rejection. In patient there were indications of immediate re-transplant - hepatic artery thrombosis. Early postoperative complications: kidney - 2 patients, respiratory 4, postoperative bleeding -, acute rejection 2, convulsions -. Mortality at year - 0. Conslusions: Liver transplantation initiated in RM is a crucial moment for the development of liver surgery in the country and ensures the improvement of life s quality, prolonging the survival ratio of patients. 62 Programme & Abstracts Liver Disease in Resource Limited Settings

63 P03 VITAMIN B2 SUPPLEMENTATION BOOSTS FIRST CLASS DIRECT-PROTEASE INHIBITORS EFFECT IN HEPATITIS C VIRUS CIRRHOTIC PATIENTS Alba Rocco*, Debora Angrisani, Debora Compare, Pietro Coccoli, Marco Sanduzzi Zamparelli, Gerardo Nardone Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University of Naples, Naples, Italy Corresponding author s marcosanduzzizamparelli@yahoo.it Introduction: We previously demonstrated that vitamin B2 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus (HCV) treated with pegylated interferons (P) and ribavirin (R) naïve to antiviral therapy. Starting from November 20, HCV NS3 / 4A serine protease inhibitors boceprevir (BOC) and telaprevir (TLV) were introduced in the clinical practice and suggested to be standard of care in patients with genotype -HCV related diseases. Aims: Aim of the study was to assess the effect of vitamin B2 on virological response in patients with HCV-related liver cirrhosis treated with BOC and TLV-based regimens. Results: 29 patients were analyzed (9 males, mean age 60 years), 4 naives and 25 experienced (2 relapsers, 2 non responders and 5 null responders). HCV genotype was a in 5 / 29 and b in 24 / 29. HVC was treated with PR+ BOC (4 / 29) or TLV (5 / 29). 9 patients reached the end of treatment. HCV-RNA was undetectable in 59% of patients at W4, 79% at W2, and 89% at W48. SVR was obtained for 38% (37% on PR+BOC, 63% on PR+TLV). Ten patients discontinued therapy for VF (n=) or AE (n=9). Conslusions: Vitamin B2 supplementation significantly improves SVR rates in HCVinfected cirrhotic patients treated with BOC and TLV-based regimens. In our view, these results are critical in terms of health expenditure for HCV-infection treatment if not available second generation direct acting antivirals. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: Consecutive patients with HCV-related compensated liver cirrhosis received P alfa-2a 80 mcg / week, weight-based R and TVL or BOC. All patients received vitamin B2 supplementation (000 mcg/day for 7 days, 000 mcg / week for 7 weeks and 000 mcg / month up to the end of antiviral therapy). Treatment efficacy data were collected at W4, 8, 2, 24 and 48 on therapy and at least 24Ws after stopping therapy. Furthermore, virologic failure (VF) and adverse events (AEs) were recorded during the full treatment period.

64 P04 EFFECT OF ANTIVIRAL THERAPY ON LIVER FIBROSIS IN PATIENTS WITH CHRONIC HCV INFECTION Alexandra Floriana Rosu*, Ionut D. Gheonea, Tudorel Ciurea, Ovidiu Zlatian2 Gastroenterology, 2Laboratory, County Clinical Emergency Hospital of Craiova, Romania, Craiova, Romania Corresponding author s kendruta@yahoo.com Introduction: Chronic infection with hepatitis C virus (HCV) is an important cause of morbidity and mortality worldwide leading to liver fibrosis and end stage liver disease. The standard treatment is Peg Interferon (PegINF) and Ribavirin (RBV). IL-28B polymorphisms (SNPs) are one of the predictive factors of treatment response. Non-invasive methods for assessment of liver fibrosis (FibroScan ) are used in patients with chronic hepatitis C. Aims: Our study wants to evaluate the effect of double therapy with PegINF and RBV on liver fibrosis in treated chronic HCV patients. We also want to demonstrate the relation between IL-28B polymorphism, sustained virological response (SVR) and the decrease of liver stiffness. POSTERS ABSTRACTS Material and Methods: : The study included 6 chronic HCV patients treated with PegINF and RBV. They were clinically and laboratory assessed before and after treatment. Their liver fibrosis was assessed by FibroScan before and after therapy. The grade of fibrosis was noted as F0/F/F2/F3/F4. The IL-28B SNP rs was analysed by genetic tests. The patients were classified as responders(r), non-responders (NR), relapsers (RR). Results: From 6 patients 27 were responders. Classification of fibrosis stage before treatment was: 3 patients in F0/F, 0 patients in F2/F3 and 4 patients F4. After treatment 6 patients were in F0/F, 9 patients were in F2/F3 and only 2 patients in F4. From 34 nonresponders/relapsers, 8 patients were in F0/F, 7 patients were in F2/F3 and 9 patients were in F4. Fibrosis stage after treatment was 7 patients in F0/F, 4 patients in F2/F3 and 3 patients in F4. 64 Programme & Abstracts Liver Disease in Resource Limited Settings

65 Analytically, ALT decreased with 84,25% in responders and,57% in non-responders, whereas AST decreased with 27,76% in responders and,57% in non-responders. The multivariate analysis of post-treatment fibrosis grade, adjusting for baseline fibrosis, sex, age over 50 years, baseline log of viral load showed that responder status is associated with a decrease of fibrosis. In multivariate analysis adjusting for sex and age the CC allele of Il-28B SNP was associated with SVR (OR=3,66, p=0,003). Conslusions: Our study showed a reduction of liver fibrosis in all patients after the treatment. The patients who achieved SVR had a higher decrease in liver fibrosis compared with non-responders and relapsers. Patients with IL-28B CC genotype had a better chance of SVR. Liver elastography is useful in monitoring therapeutic effects on liver fibrosis in treated HCV patients. POSTERS ABSTRACTS Disclosure of Interest: A. F. Rosu: Grant/Research Support: Acknowledgement. The research/the study/work was (partially) funded by POSDRU grant no. 59/.5/S/36893 grant with title: Parteneriat strategic pentru creșterea calității cercetării științifice din universitățile medicale prin acordarea de burse doctorale și postdoctorale DocMed. Net_2.0., I. Gheonea: : None Declared, T. Ciurea: : None Declared, O. Zlatian: : None Declared EASL Monothematic Conference Bucharest, Romania May 29-30,

66 P05 HBSAG AND HBEAG SEROCLEARANCE IN TREATED PATIENTS WITH HEPATITIS B VIRUS AND HIV CO-INFECTION IN SUB-SAHARAN AFRICA Anders Boyd*, Sarah Maylin2, Raoul Moh3, Delphine Gabillard4, Serge Paul Eholie3, Christine Danel3, Xavier Anglaret4, Fabien Zoulim5, Pierre-Marie Girard6, Constance Delaugerre2, Karine Lacombe6 iplesp, INSERM UMR_S36, 2Hôpital Saint-Louis, Paris, France, 3PAC-CI, Abidjan, Cote d Ivoire, 4INSERM U897, Bordeaux, 5INSERM U052, Lyon, 6Hôpital Saint-Antoine, Paris, France Corresponding author s anders.boyd@upmc.fr Introduction: In Sub-Saharan Africa, seroclearance of Hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), including their quantifiable markers, have rarely been evaluated during long-term antiviral treatment among patients coinfected with HIV and hepatitis B virus (HBV). Aims: The aim of this study was to estimate rates of HBsAg- and, among HBeAg-positive patients, HBeAg-seroclearance, as well as the predictive capacity of HBsAg quantification (qhbsag) in treatment outcomes in this patient population. POSTERS ABSTRACTS Material and Methods: A total of 6 antiretroviral (ART)-naïve HIV-HBV coinfected patients, who initiated either lamivudine (LAM)- or tenofovir (TDF)/emtricitabinecontaining ART (n=76 and n=85, respectively), were selected from two randomizedcontrol trials in Côte d Ivoire. HBV-DNA was quantified using an in-house assay (detection limit=2 copies/ml). qhbsag in IU/mL and HBeAg quantification (qhbeag) in Paul Ehrlich Institute Units/mL (PEIU/mL) were determined using the Elecsys assay (Roche Diagnostics, Meylan, France). Results: Of those included, median age was 35 years (IQR=30-4), median CD4+ cell count was 32 cells/mm^3 (IQR= ), and 33 (20.5%) were HBeAg-positive. Median treatment duration was 35.5 months (IQR: ). Among HBeAg-positive patients, cumulative proportion with HBeAg-seroclearance was 46.3% (n=4). Overall, 0 patients had HBsAg-seroclearance giving a cumulative proportion of 4.2%. Lower baseline qhbsag levels and strong 2-month declines in qhbsag were significantly associated with HBsAgseroclearance for both HBeAg-negative and positive patients. 66 Programme & Abstracts Liver Disease in Resource Limited Settings

67 In terms of predicting HBsAg-seroclearance at month-36, baseline qhbsag levels of <000 IU/mL gave fairly high sensitivity (0.82) and specificity (0.90), whereas patients with > log0 IU/mL decrease in qhbsag after 2-months of therapy had low sensitivity (0.43) and very high specificity (0.96). Baseline qhbsag-levels of >4 log0 IU/mL were mildly accurate predictors of patients exhibiting low-level HBV replication, rebounds in HBVDNA or non-response (sensitivity=0.80, specificity=0.62, positive predictive value=0.4, negative predictive value=0.90). POSTERS ABSTRACTS Conslusions: HBsAg seroclearance rates are not common in patients from Sub-Saharan Africa treated with anti-hbv containing ART. Baseline qhbsag levels may accurately predict HBsAg-seroclearance, but might not be a good predictor of poor or suboptimal HBV virological response in this context. EASL Monothematic Conference Bucharest, Romania May 29-30,

68 P06 IDENTIFYING PATIENTS INFECTED WITH HEPATITIS B VIRUS IN SUB-SAHARAN AFRICA: POTENTIAL FOR MISCLASSIFICATION Anders Boyd*, Sarah Maylin2, Raoul Moh3, Delphine Gabillard4, Hervé Menan3, Christine Danel3, Xavier Anglaret4, Serge Paul Eholie3, Pierre-Marie Girard5, Fabien Zoulim6, Constance Delaugerre2, Karine Lacombe5 iplesp, INSERM UMR_S36, 2Hôpital Saint-Louis, Paris, France, 3PAC-CI, Abidjan, Cote d Ivoire, 4INSERM U897, Bordeaux, 5Hôpital Saint-Antoine, Paris, 6INSERM U052, Lyon, France Corresponding author s anders.boyd@upmc.fr Introduction: Establishing hepatitis B virus (HBV) infection could partly depend on the type of assay used and whether patients have occult HBV infection, which frequently occurs in Sub-Saharan Africa. Aims: We illustrate these problems during a validation study among antiviral-naïve patients from Côte d Ivoire. POSTERS ABSTRACTS Material and Methods: Patients infected with the human immunodeficiency virus (HIV) and HBV were included from two prospective, randomized, open-label studies. At inclusion, Hepatitis B surface antigen (HBsAg) was first tested using the MiniVidas assay (Biomérieux, detection limit=0.09 ng/ml) and then validated from stored serum samples using the Architect assay (Abbott, detection limit=0.03 IU/mL). HBV-DNA viral loads (VLs) were quantified using an in-house polymerase chain reaction assay (detection limit=2 copies/ ml) and anti-hepatitis B core antibodies (anti-hbcab) using a semi-quantitative assay. Results: At inclusion, 234 patients tested positive for HBsAg with the MiniVidas test. These patients were predominately females (68.0%) with median age of 35 years (IQR=3040). Of them, 3/234 (3.3%) patients had HBsAg-negative serology in the validation step while using the Architect assay. Among those with discordant results, /3 (35.5%) had detectable HBV-DNA, in whom the median level was 3.03 log0 copies/ml (IQR= ) and thus could be qualified as having occult HBV infection. In these same patients with available samples, 8/27 (66.7%) had anti-hbcab positive serology with a median result at 7.6 S/CO (IQR=5.-9.0), indicating past HBV-exposure. 68 Programme & Abstracts Liver Disease in Resource Limited Settings

69 During a median 36.7 months (IQR= ) of follow-up, 30/3 (96.8%) patients with discordant results maintained HBsAg-negative status with the Architest test. The only other patient became HBsAg-positive with the Architect test (HBsAg-level=509 IU/mL) after 2-months from initiating a lamivudine-containing antiretroviral regimen, while HBV-DNA VL declined from 7.0 log0 copies/ml to undetectable in the same timeframe. Meanwhile, anti-hbcab status fluctuated between negative and positive in 4/27 (4.8%) patients with discordant results, exhibiting differences in anti-hbcab results ranging between S/ CO. POSTERS ABSTRACTS Conslusions: The MiniVidas with lower detection thresholds most likely identified both occult and overt HBV-infection, causing the discrepancies observed in this study. These findings highlight a major concern for misdiagnosis and the need for appropriate means to distinguish those with specifically overt HBV-infection. EASL Monothematic Conference Bucharest, Romania May 29-30,

70 P07 EFFICACY AND SAFETY OF TRANSARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH INTERMEDIATE AND ADVANCED STAGES HEPATOCELLULAR CARCINOMA Benjarat Promjunyakul, Chalermrat Bunchorntavakul* Gastroenterology, Rajavithi Hospital, Bangkok, Thailand Corresponding author s dr_chalermrat@yahoo.com Introduction: Transarterial chemoembolization (TACE) is the standard of care for patients with intermediate stage hepatocellular carcinoma (HCC). However, in real-world practice, TACE is sometimes unavoidably utilized in patients with more advanced stages of HCC, including in those with portal vein thrombosis/invasion (PVT) and/or extrahepatic metastasis. The efficacy and safety data of TACE in these settings is limited. Aims: To determine the efficacy and safety of TACE in patients with intermediate and advanced stages HCC according to Barcelona Clinic Liver Cancer (BCLC) staging system. POSTERS ABSTRACTS Material and Methods: Data of consecutive patients with intermediate and advanced HCC who underwent TACE between 2008 and 202 in a single tertiary center (Rajavithi Hospital, Bangkok) were reviewed. Selective TACE was performed by 3 experienced radiointerventionists using mitomycin-c mixed with lipoidol and gelfoam. HCC patients with BCLC-B were classified as standard TACE criteria (STC) group, whereas patients with BCLC-C or beyond were classified as extended TACE criteria (ETC) group. The primary endpoint was overall survival. Secondary endpoints were adverse events and objective tumor response of TACE. Results: A total of 0 HCC patients were included in the analysis: mean age 54 years, 53% hepatitis B positive, 23% Child-Pugh B and 89% tumor size 5 cm. There was no significant difference in overall survival between the STC (n=56) and the ETC group (n=54): median survival 9.6 vs 7.7 months, respectively; p=0.535) Progressive disease by modified RECIST criteria was more common in ETC than in STC group (3.5% vs 0.7%, p=0.007). Pretreatment MELD score, PVT and TACE-related complications were independent factors for survival in a multivariate analysis. The median survival of patients with (n=40) and without PVT was 5.6 and.2 months (p<0.00), respectively. 70 Programme & Abstracts Liver Disease in Resource Limited Settings

71 There was no difference in survival between patients with (n=3) and without extrahepatic metastases (9.6 vs 8.5 months, respectively; p=0.784). The incidence of TACE-related complications were similar between the two groups (p<0.05): 32.% liver decompensation with 3.6% death in STC group; and 35.2% liver decompensation with 5.6% death in ETC group. POSTERS ABSTRACTS Conslusions: The overall survival and adverse events following TACE were comparable between HCC patients with BCLC stage B and C. These findings support the use of TACE as an option to slow HCC progression in selected patients with BCLC-C, including in those with partial PVT and/or extrahepatic metastasis. EASL Monothematic Conference Bucharest, Romania May 29-30, 205 7

72 P08 THE CHANGING PATTERN OF GENOTYPE DISTRIBUTION AMONG CHRONIC HCV INFECTED PATIENTS IN GREECE DURING THE LAST 2 YEARS AND HIS POSSIBLE IMPACT IN THE NATIONAL HEALTH ECONOMICS IN THE ERA OF CRISIS Dimitrios Dimitroulopoulos*, Eftheria Petroulaki2, Sofia Gjovasho3, Dimitrios Kypreos, Klisthenis Tsamakidis, Dimitrios Xinopoulos Gastroenterology, Agios Savvas Hospital, 2Intrernal Medicine, OKANA, 3Cardiology Clinic, ONASION Hospital, Athens, Greece Corresponding author s dimdim@otenet.gr Introduction: Information regarding the changing pattern of hepatitis C virus (HCV) genotypes in Greece during the last decade is not yet well known. Aims: The aim of our study was to evaluate the frequency distribution of HCV genotypes and his changing pattern during the last 2 years among chronic HCV infected Greek patients. Material and Methods: The data of 598 consecutive, only Greeks in origin, naive patients (476 M, 22 F) that underwent treatment in our center for chronic HCV infection during the last 2 years ( ), were reviewed retrospectively. POSTERS ABSTRACTS Results: The majority (63.5 %) of our patients were between years old at the time of diagnosis. Intravenous drug use was the main route of HCV transmission (8.4 %). 49 (24.9 %) patients were infected with genotype, 6 ( %) with genotype 2, 350 (58.5 %) with genotype 3 and 93 (5.5 %) with genotype 4. A changing pattern of HCV genotype prevalence was observed, with an increase in the relative proportion of genotype and a decrease of genotypes 3 and 4 (figure for all patients, figure 2 for females, and figure 3 for males). During the first 9 studied years ( ), 3 was the predominant genotype with a percentage > 50% yearly. The last 2 years (202 and 203) the percentage of genotype was increased to 55.3 % and 53 % respectively. Reviewing the data of the last 3 years 99(67.8%) out of 46 patients achieved SVR to interferon/ribavirin treatment. For the rest of them, are necessary retreatment with newer antiviral agents, but according to the patients insurance statement and the rules of the Greek Health System almost 70% of them have not access to these drugs do to their high cost. Conslusions: This changed HCV genotype pattern might have direct impact on the disease outcome, the future therapeutic approaches and the health economics of the country. 72 Programme & Abstracts Liver Disease in Resource Limited Settings

73 P09 MORPHOLOGICAL FEATURES OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS Dzmitry Haurylenka* Internal Medicine, Gomel State Medical University, Gomel, Belarus Corresponding author s dm.gavrilenko89@gmail.com Introduction: The spontaneous bacterial peritonitis (SBP) is diagnosed only by the examination of ascitic fluid (AF). Therefore data about morphological changes of peritoneum in cirrhotic patients with SBP rarely occur in publications. In 963 H.O.Conn was the first who used the term «spontaneous peritonitis» and described acute jejunitis at of 5 cirrhotic patients with neutrophils in AF. Aims: To confirm the morphological features of SBP in cirrhotic patients. Results: All patients were Child-Pugh class B and C. The frequency of various types of infections by autopsy was following: 4,9%; 95%CI: 36,3-47,6 (hospitalized patients) and 34,3%; 95%CI: 23,2-45,4 (outpatients). There are signs of peritoneal inflammation at autopsy among 378 patients (M/F: 240/38, mean age: 52 years) were found in 9 patients without a detectable intra-abdominal, surgically treatable source of infection. There were 8 cases among the hospitalized patients (2.6%; 95%CI:.-5.) and one outpatient (.4%). Etiologies of cirrhosis were: alcohol/cryptogenic: 8/. During examination of abdominal cavity following gross findings was made: turbid AF, fibrin deposition on the small intestine s serosa. Histological changes were the following: serofibrinous peritonitis with massive polymorphonuclear cell infiltration of the omentum and small intestine serosa. The term ascites-peritonitis has been used by pathologists for the described features in their conclusions. According to medical records SBP has been diagnosed in 2 hospitalized patients after paracentesis (clinical symptoms were is abdominal pain, tenderness, fever, neutrophilic leukocytosis). However, the gross and histological findings, without an evident intra-abdominal, surgically treatable source of infection have been found in 3 patients. Conslusions: In cirrhotic patients the frequency of peritonitis, in the absence of an evident intra-abdominal, surgically treatable source of infection, was low (2.4%; 95%CI:.-4.5). But the present study confirms that in SBP can develop features of classical peritonitis. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: There was a retrospective study that enrolled 308 hospitalized patients with cirrhosis (City Hospital s medical records) and 70 outpatients with cirrhosis (Department of Forensic Medicine s autopsy database). A total of 378 patients with decompensation cirrhosis died from 2000 to 200. The SBP was diagnosed according to standard criteria.

74 P0 THE ALCOHOL CONSUMPTION IN PATIENTS WITH CHRONIC B AND C HEPATITIS Elena C. Rezi*, Romeo Mihaila2, Laurentiu Nedelcu3, Ovidiu Fratila4 Internal Medicine Department, Polisano Medical Clinic, 2Medical Faculty, Lucian Blaga University, Sibiu, 3Medical Faculty, Transilvania Univeristy, Brasov, 4Medical Faculty, Oradea University, Oradea, Romania Corresponding author s crimuntean@yahoo.com Introduction: Viral infections favour the development of alcoholic liver diseases; these two factors, alcohol and viruses, potent themselves. Ethanol intake is an independent predictor of liver cirrhosis in subjects with chronic HCV or HBV infection. Aims: Our aim was to study the prevalence and some consequences of alcohol consumption among patients chronically infected with HCV or HBV. POSTERS ABSTRACTS Material and Methods: We have considered all the patients who were hospitalized in the medical departments of the County Hospitals from three major cities from Transylvania during ten weeks, and who were ultrasonografically examined. We have studied the prevalence of HCV and HBV infection and the association of these diseases with alcohol consumption. Results: A total number of 377 patients were examined. The prevalence of the infection with HCV was of 7.5% (04 patients). 3.88% of them were also alcohol consumers. There were analyzed the patients with HCV who did not consume alcohol, as compared with those who are also consuming alcohol. At the last ones, there were found significantly higher values of the next parameters: the degree of liver steatosis (p=0.02), the spleen diameter (p=0.05), TGO (p= ), TGP (p=0.0062), GGT (p=0.0006), total bilirubine level (p=0.027). The patients with viral C hepatitis who are also alcohol consumers, are, generally younger than those with viral C hepatitis who do not consume alcohol (p=0.02). Also, the Forns index of liver fibrosis was higher in patients with HCV who were also alcohol consumers, as compared with those with HCV who do not consume alcohol (5.56, as compared with 5., p=0.22). 74 Programme & Abstracts Liver Disease in Resource Limited Settings

75 The prevalence of the infection with HBV was of.8% (25 patients). The medium age of the patients with HBV was 48.44±2.63 years. 6% of the patients chronically infected with hepatitis B virus admitted alcohol consumption. There were found significantly higher values of the next parameters: the degree of liver steatosis (p=0.009), the triglycerides level (p=0.06), the glycemic level (p=0.046), the level of GGT (p=0.042), Forns index of liver fibrosis (p=0.296) in the patients who were infecteed with HBV virus and also are alcohol consumers. POSTERS ABSTRACTS Conslusions: The alcohol consumption among patients chronically infected with HCV and HBC is pretty high, this fact being also involved in the response to the antiviral treatment. The patients who are infected with HCV or HVB and also consume alcohol have a higher steatosis grade and a higher degree of cytolysis and cholestasis. EASL Monothematic Conference Bucharest, Romania May 29-30,

76 P PROFILING CHRONIC HCV PATIENTS FOR NEW THERAPIES Elena Laura Iliescu*, Letitia M. Toma, Georgiana Minzala, Carmen Orban Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania Corresponding author s letitia_toma@yahoo.com Introduction: Chronic HCV infection is a major health issue worldwide, with a severe impact both on patients and national healthcare funds. Recent treatments have shown excellent sustained virologic response (SVR) rates; in a limited resources setting, however, access to new therapies is almost impossible and patients treated with standard double therapy (peg- interferonum and ribavirin) who do not achieve SVR are left with no alternative. Aims: We aim to study the characteristics of patients with genotype chronic HVC hepatitis in whom double therapy did not prove to be curative and who should have access to newer treatments. POSTERS ABSTRACTS Material and Methods: This is a retrospective observational study including 620 patients with chronic HCV hepatitis undergoing treatment with peg-interferonum and ribavirin, admitted to our clinic from April 203 to October 204. Patients are classified as responders, relapsers and non responders according to the guidelines. We present the characteristics of the relapsers and nonresponders at the end of the antiviral therapy. Results: Out of the 620 patients, 56.46% were nonresponders, 33.87% were relapsers and 9,67% achieved SVR (the control group). Out of the nonresponders, 45.36% stopped treatment after 2 weeks. The mean age in the cohort was 5.20 years % of the patients were women. The mean age of patients with SVR, nonresponse and relapse was 4.66, 5.62 and years, respectively; the patients with SVR were statistically younger than patients without SVR. Mean ALT levels were significantly higher in patients with relapse (02.52 UI/ml) compared to nonresponders (62.4UI/ml) and responders (38.4UI/ ml). Liver stiffness measured by Fibroscan also differs between groups: nonresponders have a higher degree of fibrosis (85.7% patients with F3-F4) compared to relapsers (66.66% with F3-F4); only 33.33% of the patients with SVR had F3 fibrosis; none had F4. There was no significant difference between HCV-RNA levels after the treatment in patients with relapse versus nonresponders. 76 Programme & Abstracts Liver Disease in Resource Limited Settings

77 POSTERS ABSTRACTS Conslusions: There is an acute need for more efficient treatments of HCV chronic hepatitis, as many patients do not achieve SVR with the double therapy. National health programmes should take into account the characteristics of these patients (elderly, with advanced liver fibrosis, high ALT levels) and select those treatments with the best safety profiles; otherwise these patients may not benefit from therapy due to severe adverse reactions. EASL Monothematic Conference Bucharest, Romania May 29-30,

78 P2 THE ROLE OF AUTOANTIBODIES (AAB) TO NON-SPECIFIC PROTEIN (NSP) IN THE PATHOGENESIS OF HEPATIC ENCEPHALOPATHY (HE) Elina Manzhalii*, Olena Baka2, Vitalii Kondratiuk3 Department of Internal Medicine propedeutics, BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, 2gastroenterology, Hospital for Scientists of the National Academy of Science of Ukraine, 3Department of Internal Medicine propedeutics, Bogomolets National Medical University, Kiev, Ukraine Corresponding author s elinam@ukr.net Introduction: Taking into account the crucial role the neurotrophic factors play in the formation and functioning of the nervous system, it is possible to assume that autoimmune reactions in form of AAB production, in particular to NSP can contribute to the development of pathological processes of these diseases. Pathogenetic mechanisms of the neural tissue damage in HE are not clearly understood. Aims: Our aim was to assess the levels of autoantibodies to nonspecific protein (NSP): neurospecific enolaza (NE), protein S00 (PS00), myelin basic protein (MBP) and cerebral antigen (CA) in patients with HE. POSTERS ABSTRACTS Material and Methods: The participants aged (avg 46,2±2,7) with liver cirrosis (LC ) were randomised into main group (MG) (n=28) with two or more documented episodes of HE (stage I-II by West Haven), which occurred within last 6 months (at least one of which -within last 3 months) and control group (CG) (n=25) without symptoms of HE. The I stage of HE was detected in 39%, stage II- 52%, latent - 9% of patients. Results: Assessment of the neurological status of MG demonstrated pseudobulbar disorders such as reflexes of oral automatism 65%, anisoreflexia 35%, staticolocomotory ataxia symptoms 54%, sensitivity disorders in 42%. 82% of the patients of MG also demonstrated the average frequency of α- rhythm - 8, ± 0,3 Hz, the reduction of its index - 2.3%, a significant decrease of the amplitude of the cognitive component on both sides and increase of the latent periods S4-377 ± 0 ms, C3 375 ± 2ms according to the EEG data with cognitive evoked potentials. Level of NE 3,22 + 0,8, PS00 8,03 + 0,3 and MBP n 34,64 +,52, cerebral antigen 28,5 + 0,94 (p <0,05) in relation to the CG. 78 Programme & Abstracts Liver Disease in Resource Limited Settings

79 The correlation coefficient between the increase of MBP level and change of frequency spectrum for α- rhythm was 0,65 (p <0,05). The correlation between the levels of MBP and CA and neurological status of patients with HE was respectively 0,62 and 0,66 (p <0.05). POSTERS ABSTRACTS Conslusions: Determination of AAB to NSP in patients with HE has a high diagnostic value. This gives us a reason to associate increase in these parameters with the process of destruction of brain tissue, which allows to predict the course of the disease and develop treatment tactics. EASL Monothematic Conference Bucharest, Romania May 29-30,

80 P3 RISK FACTORS FOR RECURRENCE OF HEPATOCELLULAR CARCINOMA AFTER RADIOFREQUENCY ABLATION IN A COHORT OF EGYPTIAN PATIENTS WITH HEPATITIS C VIRUS-INDUCED CIRRHOSIS: A DOUBLE CENTER ANALYSIS. Eslam Habba*, Mohamed Sharaf-Eldin, Sahar El-Yamany, Mohamed Ghazy 2 Tropical medicine,hepatology & gastroenterology, Tanta faculty of medicine,egypt, Tanta, 2 Radiology, Ain-Shams faculty of medicine, Cairo, Egypt Corresponding author s EAH2007@YAHOO.COM Introduction: Hepatocellular carcinoma (HCC) is one of the major complications of liver cirrhosis. Radiofrequency ablation (RFA) is the treatment of choice for patients with an early-stage HCC who are not candidates for surgical management; however, it is associated with a recurrence rate as high as 5 30% after year. Aims: The aim of this study was to analyze the risk factors for HCC recurrence in Egyptian patients after RFA. POSTERS ABSTRACTS Material and Methods: This study was conducted on a cohort of HCC patients presented to two large referral centers for management of HCC in Egypt from November 2009 to January 20. Only patients with an early-stage HCC (BCLC stage A), eligible for RFA, were included in the analysis and followed up for a period of year. Patient and tumor related risk factors associated with recurrence were studied. Statistical analysis was performed using SPSS software. Forty-five patients were included in this study and classified into two groups: group I included patients who developed recurrence during follow-up (n= 30, 66.6%) and group II included patients who did not show any recurrence during follow-up (n= 5, 33.3%). Results: The risk factors associated with recurrence included smoking (70% in group I vs. 40% in group II, P= 0.05), hepatomegaly (50% in group I vs. 40% in group II,P= 0.00), splenomegaly (90% in group I vs. 53.3% in group II,P= 0.00), heterogeneous liver (30% in group I vs. 6.66% in group II,P= 0.00), bilobar involvement (20% in group I vs. 6.66% in group II,P= 0.00), and tumors in contact with hepatic capsule (20% in group I vs. 6.66% in group II,P= 0.07). 80 Programme & Abstracts Liver Disease in Resource Limited Settings

81 Conslusions: Hepatomegaly, liver heterogeneity, and splenomegaly (a sign of portal hypertension) together with the tumor factors such as large size, bilobar involvement, and proximity to liver capsule were the factors that showed a significant association with tumor recurrence in this study. POSTERS ABSTRACTS Figure or Table: EASL Monothematic Conference Bucharest, Romania May 29-30, 205 8

82 P4 BURDEN OF DISEASE PRESENTING TO THE FIRST LIVER CLINIC ESTABLISHED IN BOTSWANA Francesca Cainelli, Thato Kaang2, Malebogo Ralethaka2, Sandy Mpho Mosenye2, Sandro Vento* Internal Medicine, University of Botswana, 2Medicine, Princess Marina Hospital, Gaborone, Botswana Corresponding author s francescacainelli@yahoo.it Introduction: Liver diseases are common and generally neglected in low and middle income countries where most patients die without a diagnosis. Dedicated services are lacking and their establishment may allow a better understanding of the extent and variety of hepatobiliary diseases. Aims: We aimed to find out the pattern of liver diseases observed in patients referred to the first Liver Clinic ever established in Botswana. POSTERS ABSTRACTS Material and Methods: All new patients referred to the Liver Clinic at Princess Marina Hospital, Gaborone (the main referral hospital in Botswana) from st August 203 (day of opening) to 25th February 205 were studied. Reasons for referral from Primary and District Hospitals or the National Blood Transfusion Center were: jaundice, abdominal distension, elevated liver enzymes, abnormal liver ultrasound, HBsAg or anti-hcv-positivity. At the clinic, age, gender, background medical information, blood tests results and imaging of all patients were recorded. The diagnostic workup included serology, abdominal ultrasound, transient elastography (Fibroscan ) of the liver and, in selected cases, liver biopsy. Results: 285 patients (44 males, 4 females; mean age 39.5 years) were observed. Chronic hepatitis B accounted for the highest prevalence (8.2% of the patients). Liver cirrhosis of different etiologies ranked next with a prevalence of 7.3% while non cirrhotic portal hypertension accounted for 5.6% of patients observed. Other conditions included hepatocellular carcinoma (7.4%), non alcoholic steatohepatitis (7.3%), drug-induced hepatitis (7%), acute hepatits B (6%), obstructive jaundice (6%), abdominal tuberculosis (4.6%), congestive hepatitis (3.5%). Patients with hepatocellular carcinoma (70.6% males) presented at stage C and D (Barcelona-Clinic Liver Cancer staging system); 3% were HBsAg positive with median alphafetoprotein level of 9,454 ng/ml. 82 Programme & Abstracts Liver Disease in Resource Limited Settings

83 Drug induced hepatitis was observed in patients on HAART and/or anti- tuberculosis treatment; efavirenz and pyrazynamide were the most commonly implicated drugs. Non cirrhotic portal hypertension was more common in females (75% of cases). POSTERS ABSTRACTS Conslusions: The establishment of a Liver Clinic in a public referral hospital of an African country is feasible and can considerably increase diagnosis and treatment of liver diseases. In just nineteen months, 33 different types of liver diseases have been diagnosed in 285 patients observed at the Liver Clinic of Princess Marina Hospital in Gaborone, Botswana. EASL Monothematic Conference Bucharest, Romania May 29-30,

84 P5 DOES THE SIZE OF THE EVALUATION BOX INFLUENCES THE RESULT OF 2D- SHEAR WAVE ELASTOGRAPHY Oana Gradinaru Tascau, Ioan Sporea*, Alina Popescu, Roxana Șirli, Ruxandra Mare Department of Gastroenterology and Hepatology Timisoara,, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania Corresponding author s bluonmyown@yahoo.com Introduction: 2D- Shear Wave Elastography (2D-SWE) (SuperSonic Imagine S.A., Aix-en-Provence, France) is an elastographic method that uses both a color-coded image superimposed on a B-mode image and a quantitative evaluation of the liver fibrosis. Aims: The aim of this study was to comparatively evaluate the accuracy of 2D-SWE liver stiffness measurements obtained with different sizes of the region of interest (ROI) placed in the color-coded map. POSTERS ABSTRACTS Material and Methods: We included 35 consecutive patients with or without hepatopathies or liver cirrhosis. The assessment was performed with the patient on fasting condition, in supine position with the right arm in maximum abduction, by intercostal approach in the right liver lobe. In each patient three liver stiffness measurements (LSM) were performed using 2D-SWE with different sizes of the ROI (0 mm, 5 mm and 20 mm) and a median value was calculated for each size and expressed in kilopascals (kpa). Valid LSM were acquired in a homogenous color-coded map. Results: The study group included 35 patients, 62.8% (22) women and 37.2% (3) men, with a mean age of 42 years, ranging between years. The mean values of the LSM obtained with the different sizes of the ROI were the following: 7.94±5.5kPa, 8±5.8kPa and 8.±5.8 respectively. There were no significant differences between the LSM with various sizes of the ROI, 0mm ROI vs.5mm ROI (p=0.96), 5mm ROI vs. 20 mm ROI (p=0.94), 0mm ROI vs. 20mm ROI (p=0.90). Conslusions: As long as the color coded map is homogenous the LSM were not influenced by the size of the ROI. 84 Programme & Abstracts Liver Disease in Resource Limited Settings

85 P6 SHEAR-WAVE ELASTOGRAPHY FOR THE ESTIMATION OF LIVER FIBROSIS IN CHRONIC VIRAL LIVER DISEASES Oana Gradinaru Tascau, Ioan Sporea*, Alina Popescu, Roxana Șirli, Ruxandra Mare Department of Gastroenterology and Hepatology Timisoara,, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania Corresponding author s bluonmyown@yahoo.com Introduction: Shear wave elastography (SWE) has been shown to be an effective tool in the non-invasive diagnosis and staging of chronic liver diseases, but it is still unclear which SWE technique is the ideal one in daily routine. Aims: The aim of this study was to evaluate the accuracy of different shear wave elastographic methods for liver stiffness assessment in patients with chronic B and C viral hepatitis. Results: : 58 subjects underwent LB and all three elastographic methods (mean age 43, range between 9-66 ; 33 women, 25 men), 43.% (25) were patients with chronic B hepatitis and 56.8% (33) with chronic C hepatitis. LS measurements were successful in 94.8% (55/58) cases for 2D-SWE, in 93.% (54/58) cases for TE and in 94.8% (55/58) cases for ARFI.. The strongest correlation with the histological result was obtained for 2D-SWE (r= 0.62, P<0.000). The values obtained for TE and ARFI were similar: r= 0.5, P<0.000; r= 0.5, P<0.0005, respectively. There were no significant differences between the correlation strength of association between LS assessment with the three elastographic methods and histological fibrosis: 2D-SWE vs. TE, z=0.82, p=0.4; 2D-SWE vs. ARFI, z=0.82, p=0.4; TE vs. ARFI, z=0, p=. Conslusions: In conclusion, 2D-SWE, TE and ARFI are feasible elastographic methods that can be performed in most patients with chronic hepatopathies B or C. It seems that 2D-SWE was the elastographic method best correlated with liver stiffness, but the difference was not significant. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: This prospective study, performed between February 203 and October 204, included 58 patients with chronic B or C hepatopathies that underwent liver stiffness (LS) measurements by three elastographic methods (Two-dimensional SWE 2D-SWE, Transient Elastography - TE and Acoustic Radiation Force Impulse Elastography - ARFI) in the same session with ultrasound-guided liver biopsie (LB). Liver histology was assessed according to the Metavir score. Reliable LS elastographic measurements were defined as: for TE and ARFI the median value of 0 LS measurements with a success rate 60% and an interquartile range<30%, for 2D-SWE the median value of 3 LS measurements obtained in a homogenous color-coded box placed -2 cm under the liver capsule. All TE measurements were performed with M probe.

86 P7 THE BEST NEEDLE SIZE FOR THE BEST LIVER BIOPSY TISSUE SAMPLE Ioan Sporea*, Felix Bende, Alina Popescu, Roxana Sirli Department of Gastroenterology and Hepatology, University of Medicine and Farmacy Victor Babes Timisoara, Timisoara, Romania Corresponding author s isporea@umft.ro Introduction: Liver biopsy (LB) is the most accurate method for staging diffuse chronic liver diseases. Aims: The aim of our study was to establish which needle size is more suitable for obtaining good LBs specimens. Material and Methods: We conducted a retrospective study on echo-assisted LBs performed in our Department in the last 0 years ( ), using.4 mm (.4N) and.6 mm (.6N) Menghini modified needles, with 2 liver passages. We compared a group of 56 LBs performed with.4n (46.% male, 53.9% female, mean age 46± years) versus a group of 56 LBs performed with.6n (42.3% male, 57.7% female, mean age 45±2 years). The parameters investigated were: number of inconclusive biopsies, length of tissue specimen, number of portal tracts, complications. POSTERS ABSTRACTS Results: All LBs investigated were conclusive and had sufficient tissue for histological assessment. Comparing the length of the fragments obtained, the mean size provided by the.6n was statistical significantly longer than the one obtained by the.4n (3.47±.02 cm vs. 3.8±.49 cm, p=0.0457). 6 LBs (3.8%) performed with the.4n vs. 5 LBs (3.2%) performed with the.6n produced less than.5 cm. In addition the.6n provided significantly more complete portal tracts then the.4n (22.4±0.5 vs. 9.2±9.3, p=0.0058). No major complications occurred in both groups. Conslusions: The.6 mm Menghini needles provide better LB specimens, with higher number of portal tracts, as compared to.4 mm Menghini needles. The.6 mm Menghini needles are more suitable for performing LBs. 86 Programme & Abstracts Liver Disease in Resource Limited Settings

87 P8 MANAGEMENT OF PRIMITIVE LIVER TUMOURS IN A SINGLE CENTER IN ROMANIA Letitia Toma*, Laura Iliescu, Radu Dumitru2, Mugur Grasu2, Carmen Orban Internal Medicine, 2Radiology, Fundeni Clinical Institute, Bucharest, Romania Corresponding author s letitia_toma@yahoo.com Introduction: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related death Aims: We aim to study the diagnosis and treatment options for HCC. Material and Methods: We used standard methods for diagnosis for HCC: radiology, determining serum alpha fetoprotein (AFP). We included 79 patients diagnosed with HCC between April 20 and May 203. Most patients in the early stage underwent local ablation, while TACE was preferred in 46 patients in the intermediate stage. Systemic therapy was the most frequent treatment for patients in the advanced stage (48 patients), followed by sorafenib (6 patients). One patient with advanced stage was given Sorafenib + Bevacizumab + Erlotinib. 2 patients with end-stage disease did not receive treatment. Survival rates depended on the HCC stage: 2-8 months in the intermediate stage and - 2 months in the advanced stage. Survival rates after liver transplant decreased in time as expected Conslusions: Early diagnosis of HCC is essential in improving the patients outcomes, as there are several classic therapeutic options and new emerging ones addressing patients with early stage disease. The combination of molecular therapies is expected to improve the outcome benefits already obtained with Sorafenib EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Results: All patients were classified and treated according to the Barcelona Clinic Liver Cancer (BCLC) staging: resection / transplant, ablation (RAF), percutaneous ethanol injections (PEI), transarterial chemoembolization (TACE), new therapies. Our study included 45 patients with early stage HCC, 67 patients with intermediate stage HCC (Stage B) and 46 patients with advanced stage HCC (Stage C). Table presents the therapeutical options and the number of patients in each group.

88 POSTERS ABSTRACTS Figure or Table: 88 Programme & Abstracts Liver Disease in Resource Limited Settings

89 P9 ACUTE KIDNEY INJURY (AKI) IN 326 HOSPITALIZED PATIENTS WITH DECOMPENSATED CIRRHOSIS (CI): FREQUENCY, ASSOCIATIONS, MORTALITY Lubomir Skladany*, Juraj Svac2, Lukas Liptak Hepatology/ Liver Transplantation, 2INTERNAL MEDICINE AND NEPHROLOGY, F.D.ROOSEVELT University Hospital, Banska Bystrica, Slovakia Corresponding author s lubomir.skladany@gmail.com Introduction: Despite joint effort of AKIN and ICA at ILC 20 to formulate new diagnostic criteria for AKI in Ci, controversies have persisted. Recently (SIG at AASLD 204), it has been proposed to adhere to the original set of criteria (Gut, 20) and to allow for adjustments after manifold external validation - with emphasis on prevalence, precipitants and clinical consequences of AKI. Aims: To investigate cohort of hospitalized patients (pts) with decompensated Ci with regard to following aspects of AKI: a)frequency; b)relationship to degree of liver failure and c)to preexisting chronic kidney disease (CKD); 2)the consequences of AKI: 2a)lenght of hospital stay (LOS), 2b) in-hospital mortality. Results: Baseline characteristics: 326 pts, 203 men (X%), age 54y (9-86), etiology of Ci = ALD in 79 (X%), viral 24 (X%), MELD 6 (6-37), Child-Pugh score (CTPS) 9 (74). LOS (days) 9,5 (-40). AKI was present in 84 pts (26%). AKI in 45(4%), AKI2 in 9(6%), AKI3 in 20(6%). Pts with AKI as compared to pts without AKI have had: higher MELD (20 vs 4,5; p<0,00; AKI-9, AKI2-2, AKI3-23); higher CTPS (0, vs 8; p<0,00); longer LOS (6 vs 7; p=0,046); and higher mortality 5% vs % in AKI, 2% in AKI2 and 55% in AKI3 (p<0,000). CKD has been diagnosed in 86 pts (26%; G2 in 58, G3 in 2, G4 in 6, G5 in ); AKI over CKD G<3 was found in 24% of pts, and AKI over CKD 3+ in 46% (p=0,009) Conslusions: AKI is frequent in patients hospitalized with decompensated Ci (26%). Its frequency increases with degree of liver failure as measured by MELD and CTPS. Its frequency increases with degree of CKD. Its presence is risk factor for prolonged LOS and mortality EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: Retrospective analysis of electronic charts of consecutive pts hospitalized between at the Liver unit (HEGITO) of university hospital with decompensated Ci. AKI was defined according to Wong (Gut 20), CKD according to KDIGO. Inclusion criterion: decompensated Ci. Exclusion: malignancy other than HCC.

90 P20 BULGARIAN MODEL FOR THE DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH CHRONIC VIRAL HEPATITIS, WHO ARE DIAGNOSED WITH OPIOID DEPENDENCE AND UNDERGO OPIOID SUBSTITUTION TREATMENT Marieta Simonova* on behalf of Bulgarian Association for The Study of the Liver, Georgi Gasilev2 on behalf of Bulgarian Addiction Institute, Lydmila Mateva3 on behalf of Bulgarian Association for The Study of the Liver, Alexander Kantchelov4 on behalf of Bulgarian Methadone Treatment Association, Krum Katzarov on behalf of Bulgarian Association of Gastroenterology Miliary Medical Academy, Clinic of Gastroenterology, 2Horizont Medical Center, 3University Hospital Ivan Rilski, 4Kantchelov Clinics, Sofia, Bulgaria Corresponding author s simonova_m@yahoo.co.uk Introduction: The prevalence of HCV and HBV infections in PWID in Bulgaria is 60 % and 6% respectively. Until 204, both injecting drug use and opioid substitution treatment (OST) were contraindications for antiviral treatment, according to the past National consensuses for the treatment of viral hepatitis. POSTERS ABSTRACTS Aims: To present the current model in Bulgaria for the diagnosis, treatment and monitoring of patients with chronic viral hepatitis, who also have opioid dependence and undergo OST. Material and Methods: The model for the treatment of PWID on OST, who are infected with HCV, HBV or HDV is based on the National consensus for diagnosis, treatment and monitoring of patients with chronic viral hepatitis, who are diagnosed with opioid dependence and undergo OST. The Consensus was prepared and adopted by Bulgarian Association for Methadone Treatment, Bulgarian Addictions Institute, Bulgarian Association of Gastroenterology and Bulgarian Association for the Study of the Liver in 204. Results: Initial selection of the patients with viral hepatitis is performed in the Programs for the OST by assessing social, psychiatric and psychological suitability of the patient for antiviral treatment. Selected patients are referred to Gastroenterology Clinics with accompanying letter for further assessment of viral hepatitis. Decision for the treatment in every patient is taken together by addiction specialist and gastroenterologist and written Expert Statement is provided for the National Health Insurance Found. Close collaboration 90 Programme & Abstracts Liver Disease in Resource Limited Settings

91 between Programs for OST and Gastroenterology Clinics continues during the whole course of antiviral treatment and list of follow-up activities listed in the Consensus, for monitoring of the psychiatric and psychological condition of the patients and the use of illegal/nonprescribed narcotic substances are applyed. Specific criteria are set for the Programs for OST to be eligible for participation in this collaborative model. New Programs for OST treatment are included every year after fulfilling requirements and passing educational course on the Consensus. POSTERS ABSTRACTS Conslusions: Our model for antiviral treatment in addicted to opioids patients on OST with viral hepatitis is a clinical collaborative model designed to ensure high treatment effectiveness and quality of care and an example of successful interdisciplinary partnership between professional organizations in the field of gastroenterology and addiction psychiatry. EASL Monothematic Conference Bucharest, Romania May 29-30, 205 9

92 P2 CLINICAL SCORES FOR THE PREDICTION OF ESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS Milica Stojkovic*, Milos Stulic, Marko Vojnovic, Djordje Culafic, Aleksandra Pavlovic Markovic Hepatology, Clinical center of Serbia, Belgrade, Republic of Serbia Corresponding author s drmilicastojkovic@gmail.com Introduction: Esophageal varices are one of the most important complication of liver cirrhosis, ant it s rupture is one of the most dramatic events in everyday practice. Considering the costs of repeated upper endoscopy there is an increasing number of studies focusing on non-invasive parameters for the assessment of clinically significant esophageal varices. Aims: Aim of our study was to determine and evaluate non-invasive parameters of clinically significant portal hypertension in patients with liver cirrhosis. POSTERS ABSTRACTS Material and Methods: Retrospective study included 74 patients with alcoholic and viral liver cirrhosis treated at Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia. All data was obtained from patients medical records including history, biochemical, ultrasonography and upper endoscopy findings. Statistical analysis was performed using SPSS for Windows. Results: The average value of the ratio RLLD/INR 0.46±3.09 and 2.24±3.43, for patients who showed evidence of esophageal varices during upper endoscopy and in those who didn t, respectively (p=0.09, p<0.05). For detection of EV, the ratio RLLD/INR with the cut-off.5 showed sensitivity 64.5%, specificity of 66.67%,.92LR+, and 0.54 LR-, with AUROC The average value of the ratio of the PC/SBD was 69.79± and 423.±908.2 for patients who showed evidence of esophageal varices during upper endoscopy and in those who didn t, respectively (p=0.0, p<0.05). The average value of the ratio of the RLLD/SA was 5.5±0.7 and 4.57±0.7 (p=0.05, p<0.05) for patients who showed evidence of esophageal varices during upper endoscopy and in those who didn t, respectively. Conslusions: Non-invasive assesment of esophageal varices using scores based on ultrasonography and laboratory results is simple, inexpensive, and could be useful tool in limiting the number of repeated upper endoscopies. 92 Programme & Abstracts Liver Disease in Resource Limited Settings

93 P22 CLINICAL PATTERN OF HEPATOCELLULAR CARCINOMA IN YOUNG PATIENTS; A TWO YEAR STUDY Pantong M. Davwar*, Mary J. Duguru, Micheal C. Okorie Internal Medicine, Jos university teaching hospital, Jos, Nigeria Corresponding author s pdavwar@gmail.com Introduction: Hepatocellular carcinoma (HCC) is a leading cause of mortality in subsaharan Africa, where Hepatitis B (HBV), Hepatitis C, Alcohol and Aflatoxins contributes to the etiology of liver cancer. Young patients are a special group who acquire hepatitis B early in life, progress fast and present late with HCC. Early screening and surveillance is not routinely available in this region. Aims: The aim of this study is to describe the pattern of HCC in young patients. Results: Males accounted for 55(74.88%) of the patients. The average age was 3±5 years and 28% subjects were living in urban areas. Those with Cirrhosis were 33 M: F 4:. Those with Hepatocellular cancer (HCC) were 49(66.2%) males and 25(37.8%) females. All patients with liver cancer had abdominal swelling paint and associated weight loss. Frequency of HCC patients with HBV infection (39) and only two patients had HCV infection and it was co-existing with HBV infection. HBV infection contributed significantly to liver cancer (OR %CI ), Alcohol (OR.2 95%CI ) did not significantly contribute to HCC in this age group. Only 9.4% of had smoked cigarettes this did not significantly contribute to HCC (OR %CI ) and 94.5% had tertiary level of education. The staple diet was a carbohydrate based meal. Family history of liver cancer did not significantly contribute to liver cancer (OR.6 CI ). Mean liver size is 7.7±4.2. There was 00% mortality in the HCC group, none received definitive treatment Conslusions: Hepatitis B virus infection was significantly associated with HCC in patients less 45 years, early diagnosis of HBV infection and prompt initiation of treatment will reduce the mortality from this complications. Community based screening for hepatitis B in this age group with surveillance for those positive and vaccination for those not infected is advocated EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: We carried out a retrospective study on all patients 45 years and below (n=207) with liver diseases, seen over a two year period in a tertiary hospital in Nigeria and reviewed the clinical records and recorded their data; demographics, clinical features, etiology of liver disease and outcome of admission.

94 P23 LIVER ENRICHED TRANSCRIPTION FACTORS MOLECULAR MARKERS FOR HEPATOCELLULAR CARCINOMA RECURRENCE AFTER LIVER TRANSPLANTATION AND LIVER RESECTION Razvan Iacob*, Codruta Vagu, Anca Nastase, Speranta Iacob, Florin Botea, Razvan Grigorie, Luminita Stoica, Vlad Herlea, Adina Croitoru, Simona Dima, Cristian Gheorghe, Liana Gheorghe, Michael Ott2, Irinel Popescu Fundeni Cinical Institute, Bucharest, Romania, 2Hannover Medical School, Hannover, Germany Corresponding author s msiacob@gmail.com Introduction: The liver enriched transcription factors (LETF) are critical in inducing and maintaining hepatic phenotype during liver organogenesis and their expression level in HCC could have prognostic implications. Aims: The aim of our study was to investigate the prognostic significance for early HCC recurrence (within 24 months following a potentially curative treatment) for LETF expression in hepatocelullar carcinoma specimens, in comparison to paired non-tumoral liver tissue from the same patients. POSTERS ABSTRACTS Material and Methods: The study group included 40 patients, 23 with liver resection and 7 with liver transplantation for HCC, with a mean follow-up after treatment of 29 months. Gene expression has been quantified by qrt-pcr, using beta-actin as reference gene for eight transcription factors: FoxA2, HNF6 (ONECUT), HNF-alpha, HNFbeta, HNF4-alpha, C/Ebp-alpha, Gata4, Gata6. Multivariate survival analysis has been conducted by Cox proportional hazards model. Clinical variables have also been included in the multivariate survival analysis: Milan Criteria, Child-Pugh C class, poorly differentiated tumor grading, type of treatment (liver resection vs. liver transplantation). Results: During follow-up, tumor recurrence has been detected in 42.5% of patients who underwent liver transplantation and 57.5% of patients after liver resection. As independent predictors for tumor recurrence have been identified: down regulation of HNF4alpha, upregulation of Gata4 and up-regulation of HNF6. Clinical variables were not independent predictors according to our multivariate survival analysis. Based on survival analysis data, a statistical model to predict recurrence after curative treatment has been generated. The model has a C-statistic of 0.83, suggesting an excellent clinical utility. A cut-off level of 0.64 of the prognostic score has a 76.5% sensitivity and a 83.3% specificity in predicting recurrence of HCC after a potentially curative treatment. Conslusions: Down regulation of HNF4alpha, and upregulation of Gata4 and HNF6 in tumoral tissue are significant independent molecular prognostic factors for tumor recurrence following a potentially curative treatment for HCC. 94 Programme & Abstracts Liver Disease in Resource Limited Settings

95 P24 WHAT IS REQUIRED FOR CONTROL AND ELIMINATION OF HEPATITIS B GLOBALLY? Shevanthi Nayagam*, Mark Thursz, Stefan Wiktor2, Daniel Low-Beer3, Timothy Hallett4 Department of Hepatology & Gastroenterology, Imperial College, London, United Kingdom, 2 Global Hepatitis Programme, 3HIV & Hepatitis, World Health Organization, Geneva, Switzerland, 4Department of Infectious Diseases Epidemiology, Imperial College, London, London, United Kingdom Corresponding author s s.nayagam0@imperial.ac.uk Introduction: Despite the availability of a safe and effective vaccine and treatment, variability of coverage means that HBV still accounts for up to one million deaths annually worldwide. Aims: To evaluate and support the potential impact of scaling up interventions against HBV, set realistic targets for elimination of transmission and mortality due to HBV and identify key developments needed to achieve them. Results: The scale-up of infant HBV vaccination to date, is already driving a decrease in new infections, and if maintained at current levels, will have averted.2m deaths by This will also result in a greater proportion of transmission being mother-to-child. Without further intervention, the number of persons living with HBV will remain at the same current high levels for the next years and there will be 20M HBV-related deaths by However, a 90% reduction in incidence of new chronic infections and 65% reduction in mortality could be achieved by 2030 with the scale-up of existing interventions: >95% coverage of infant vaccination, 80% coverage of birth dose vaccine and 73% coverage of treatment for all those eligible (implemented from c. 2020). EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: A dynamic, age, sex and region-structured mathematical model of the worldwide HBV epidemic was constructed incorporating data on epidemiology, vaccination coverage, treatment, regional demography and the natural history of HBV. The model was used to generate predictions regarding incidence of new chronic HBV infections, prevalence and HBV related mortality under assumptions that interventions remain at current levels ( status quo ). We then used the model to estimate the impact of scaling up of both prevention and treatment interventions, to establish what would be sufficient to bring HBV to the threshold of control and elimination by 2030.

96 This would amount to 3M deaths averted worldwide by 2030, including 6M cases of cancer. The global cost is forecast to peak at $7.5 B annually but decline rapidly after 2030, and could be accelerated if a cure is developed. Conslusions: The fight against HBV through universal infant vaccination has scored major victories in reducing new infections in some settings but, without further intervention, prevalence and mortality will remain high for decades. However, expansion of vaccination and treatment could reduce deaths by 65% and transmission by 90%. Although the costs are high, they peak at lower values and decline more rapidly than those projected for other infectious diseases with similar burden. POSTERS ABSTRACTS Figure or Table: 96 Programme & Abstracts Liver Disease in Resource Limited Settings

97 P25 PREVALENCE OF HEPATITIS C CO-INFECTION IN HIV PATIENTS IN PHNOM PENH, CAMBODIA. PRELIMINARY FINDINGS. Sokkab An*, Anja De Weggheleire2, Syna Teav, Irith De Baetselier2, Sopheak Sok, Veasna So, Sokchea Sea, Sreyphors Ros, Sopheak Thai, Johan van Griensven2, Sven Francque3, 4, Lutgarde Lynen2 Infectious Diseases, Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia, 2Clinical Sciences, Institute of Tropical Medicine Antwerp, 3Gastroenterology Hepatology, 4Laboratory of experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium Corresponding author s adeweggheleire@itg.be Introduction: Knowing its epidemic is a critical determinant for health resource prioritization at country level. Robust prevalence data on the hepatitis C epidemic are currently missing for Cambodia, as for most low and middle income countries. Aims: With our study, we aim to contribute to the knowledge on the burden of hepatitis C/HIV co-infection in Cambodia, by documenting the hepatitis C prevalence and genetic diversity in one of the country s largest HIV cohorts. Results: As of 7 February 205, 695 out of the 3435 adult patients of the HIV cohort have been screened, including 39 women. Mean age of those screened was 43 ± 8,7 years and most (N=68, 97,9%) are on antiretroviral therapy. Most-at-risk populations (MARPs), including sex workers, men who have sex with men, and injection drug-users were rare (N=3) among the screened. Fifteen patients refused participation. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: A cross-sectional study, started in November 204, enrolls all adult consenting HIV patients followed up in Sihanouk Hospital Center of Hope in Phnom Penh Cambodia. HCV screening and diagnosis is offered as per 203 CDC algorithm (Elecsys Anti-HCV immunoassay of Roche Diagnostics, followed by COBAS AmpliPrep/COBAS TaqMan HCV Quantitative Test, v2.0). Genotyping is run on the Mx3000P (Stratagene - Agilent technologies) with the QPCR kit (Stratagene Quaigen provided by Viet A technology corporation).

98 Sixty-two (8,9%) patients tested positive for HCV IgG antibodies, and of those 29 (46,8%) were identified having a current infection (HCV-RNA positive). Viral load was > IU/ml in 2 patients, and > 6 million IU/ml in 8 patients. Mean age of coinfected patients is 47 +/- 9,7 years and male/female ratio 0,3. No patients with triple (HCV/HBV & HIV) infection have been identified. Genotype testing revealed that the large majority is genotype, 27 out of 29. The two remaining patients were carrying genotype 2 (N=) and genotype 6 (N=) HCV. POSTERS ABSTRACTS Conslusions: The current available results indicate that the prevalence of chronic hepatitis C in this moderate risk cohort (HIV, but rarely MARPs) is 4 %. The majority of co-infected patients carry genotype, only 0,7 % carry other genotypes. 98 Programme & Abstracts Liver Disease in Resource Limited Settings

99 P26 RECIPIENT AND DONOR FACTORS PREDICTING POSTTRANSPLANT SURVIVAL IN THE ROMANIAN NATIONAL TRANSPLANT PROGRAM Speranta Iacob*, Liana Gheorghe, Daniela Tabacelia, Razvan Iacob, Cristian Gheorghe, Irinel Popescu Fundeni Cinical Institute, Bucharest, Romania Corresponding author s msiacob@gmail.com Introduction: An ideal liver allocation system should reduce waitlist mortality and also improve posttransplant survival. Considering survival benefit, MELD score is an inaccurate predictor of posttransplant survival. In Romania, the current allocation policy includes calculation of MELD/ MELD-Na score and complications of cirrhosis underweighted by MELD score, including hepatocellular carcinoma (HCC). Aims: To identify a new scoring system that predicts recipient survival at 3 months following liver transplantation (LT) in the National Romanian Liver Transplant program. Results: Posttransplant overall survival was 84.2% at 3 months with no differences between the MELD categories at LT (<7 =82.4%, 7-25=88.4%, >25=75%, p=0.7). Recipients with HCC outside Milan criteria had a significantly lower MELD score at LT compared to patients with HCC inside Milan (p=0.008, 4.6±3.9 vs 7.±5.) and received a higher proportion of marginal organs (p=0.005, 65.4% vs 27.9%), but survival after LT did not differ (p=0.47). Independent risk factors for survival following LT were: recipient age >53 years (p=0.0), serum albumin <2.7g/dL (p=0.02), diabetes mellitus (p=0.4), hyponatremia <30mmol/L, presence of non-malignant portal vein thrombosis (p=0.0), retransplantation (p=0.0005) and donor resuscitation following cardiac arrest (p=0.03). AUROC of RoSOFT score is 0.86 in both training and validation set. Diagnostic accuracy of RoSOFT for predicting 3 months mortality is 89.6%. Conslusions: Combined recipient and donor risk factors as included in the new reported score (RoSOFT) can accurately predict 3-months survival following LT in our National Liver Transplant Program and can improve donor-recipient matching. Patients with HCC outside Milan can receive marginal livers with good posttransplant outcomes given the lower MELD score at LT. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: We included into analysis 242 adult patients (83 patients within the training set and 59 in the validation cohort) with liver cirrhosis consecutively transplanted in Romania between January June 204. We formulated a score to predict 3 months survival outcomes following LT (RoSOFT) that includes both donor and recipient factors to evaluate transplants at the time of LT.

100 P27 ANTICOAGULANT THERAPY AND OUTCOME OF PATIENTS WITH LIVER CIRRHOSIS AND NON-MALIGNANT PORTAL VEIN THROMBOSIS Speranta Iacob*, Carmen Ester, Cora Pop2, Razvan Iacob, Cristian Gheorghe, Irinel Popescu3, Liana Gheorghe Gastroenterology and Hepatology Department, Fundeni Cinical Institute, 2Gastroenterology Department, Universitary Hospital, 3General Surgery and Liver Transplantation Center, Fundeni Cinical Institute, Bucharest, Romania Corresponding author s msiacob@gmail.com Introduction: Portal vein thrombosis (PVT) is relatively common in candidates for liver transplantation (LT) and long-term outcome of patients with PVT who undergo LT is not well defined. Anticoagulation is a challenging therapy in individuals with decompensated liver cirrhosis because of the well-recognized coagulation abnormalities and of the increased risk of bleeding. Aims: To investigate the risk factors for overall and bleeding-related death in a cohort of cirrhotic patients with PVT. POSTERS ABSTRACTS Material and Methods: We tested separately the association between different parameters and overall death while on the waiting list using Cox regression model. Results: There were 68.3% men with a mean age of 53.0 ± 9.8 years, 30.8% of patients had HCV and 36.5% had HBV-related cirrhosis. 46.% of patients received anticoagulation and 38.2% of them have achieved recanalization of the PVT, while 42.9% remained stable after 3 months of anticoagulant therapy. Overall death was observed in 3.7% of patients, out of whom 4 (3.5%) were hemorrhage-related. 6.3% of patients were transplanted. The following independent risk factors for overall death were: thrombosis extended to superior mesenteric vein (p=0.04), refractory ascites requiring frequent paracentesis (p=0.0), shorter time from liver cirrhosis to PVT diagnosis (p<0.000). The single risk factor associated with bleeding-related death was the administration of anticoagulation therapy (p=0.002). Conslusions: Anticoagulation therapy is efficacious for recanalization or stabilization of the thrombotic process in patients with liver cirrhosis awaiting LT and should be continued until LT is performed. Anticoagulant therapy is not an innocuous intervention being associated with a high risk of bleeding-related death, but not with overall death on the waiting list. 00 Programme & Abstracts Liver Disease in Resource Limited Settings

101 P28 TREATMENT OF SEVERE RECURRENT HEPATITIS C IN LIVER TRANSPLANT RECIPIENTS USING NEW ANTIVIRALS LIMITED EXPERIENCE OF A LARGE VOLUME TRANSPLANTATION CENTRE IN A LRS Liana Gheorghe, Speranta Iacob*, Irinel Popescu2 Gastroenterology and Hepatology Center, 2General Surgery and Liver Transplantation Center, Fundeni Cinical Institute, Bucharest, Romania Corresponding author s msiacob@gmail.com Introduction: Treatment of recurrent hepatitis C after liver transplantation (LT) has radically changed with the recent approval of all-oral interferon-free regimens due to higher efficacy and better tolerability in this population. However, in limited resource settings (LRS), using new direct-acting antivirals in combination with Peginterferon and Ribavirin still remain an option. Aims: To present our limited experience with boceprevir and sofosbuvir interferon-based regimens in patients with severe recurrent hepatitis C after LT. Results: In the Boceprevir group, on-therapy virologic response (VR) after lead-in phase and 2 weeks was 33.3% (2/6 patients) and 00% (6/6 patients), respectively; end-of-therapy VR in this group was 00% (6/6 patients), but SVR24 was 83.5% (5/6 patients). However, in 4 LT recipients treated with Boceprevir-based regimen, therapy was prematurely stopped due to severe adverse events after 4 (immune induced hepatitis), 6 (severe anorectal symptoms), 7 (autoimmune cholangitis) and 9 months (severe anemia requiring repeted transfusions and denutrition). Despite the premature discontinuation of therapy, only the last patient relapsed. Four out of six patients treated with Boceprevir developed severe anemia requiring eritropoetin (EPO) and blood transfusions. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: From a cohort of 09 patients with recurrent hepatitis C after LT, 3.75% had severe recurrence within the first year (F4 or FCH). Six patients with severe recurrent hepatitis C were treated with Boceprevir 800 mg three times daily orally, Peginterferon alpha2b.5µg/kg/week subcutaneously and Ribavirin mg/day orally for 48 weeks, and 3 patients received Sofosbuvir 400mg, Peginterferon alpha2a 80µg/week subcutaneously and Ribavirin mg/day orally for 24 weeks.

102 In the Sofosbuvir group, on-therapy VR was 00% at 4, 2 and 24 weeks, SVR4 00% (3/3 patients), while SVR2 is not yet available. One patient in this group, showing moderate renal impairment (creatinine clearance 55ml/min) presented mild-to-moderate anemia during the therapy, requiring Ribavirin dose reduction and EPO administration. POSTERS ABSTRACTS Conslusions: Although carefully monitoring and intervention during therapy allowed achieving a high SVR24 of 83.5%, Boceprevir-based therapy was associated with severe adverse events, expensive interventions and therapy discontinuation. Sofosbuvir based therapy in combination with Peginterferon and Ribavirin is not only highly curative but also well tolerated in patients with severe recurrent hepatitis C after LT. 02 Programme & Abstracts Liver Disease in Resource Limited Settings

103 P29 OUTCOME OF TRANS-ARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH LIVER CIRRHOSIS AND HEPATOCELLULAR CARCINOMA Speranta Iacob*, Razvan Cerban, Mugur Grasu2, Radu Dumitru2, Razvan Iacob, Cristian Gheorghe, Ioana Lupescu2, Liana Gheorghe Gastroenterology and Hepatology Center, 2Radiology Department, Fundeni Cinical Institute, Bucharest, Romania Corresponding author s msiacob@gmail.com Introduction: Treatment of hepatocellular carcinoma (HCC) is often complex and multidisciplinary. Trans-arterial chemoembolization (TACE) is an effective palliative treatment in patients with middle and advanced stage HCC. Aims: The aim of this study was to evaluate factors influencing survival of patients with liver cirrhosis and HCC undergoing TACE. Results: There were included 74% males and 26% females with a mean age of 6.2 ± 9 years. 55.4% of patients had liver cirrhosis due to HCV infection. Mean overall survival from first session of TACE is 3 months. Mean MELD score at time of TACE was 9.4 ± 2.8. TACE with DC-beads was performed in 26% of patients. Six patients were transplanted after TACE. 74.3% of patients had HCC within Milan criteria and the mean diameter of the biggest nodule was 38.6 ± 8.9 mm. Factors identified to influence survival after first session of TACE were: lower serum albumin prior to TACE (p=0.005), higher INR (p=0.0), higher MELD score (p=0.0) and higher bilirubin levels (p=0.02). Presence of esophageal varices reached only marginal significance. No tumor related factor, AFP value, complete response to TACE after one month or progression of tumor after TACE did not influence survival. Complete response to TACE after one session was encountered in 44.6%. Conslusions: Short term survival after TACE in patients with liver cirrhosis and HCC is related to liver insufficiency and not to tumor related factors. TACE can be safely performed with a good outcome in cirrhotics Child Pugh class A or B. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: Treatment-naïve 74 patients with liver cirrhosis and HCC undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Cox-regression analysis was performed for finding factors altering survival.

104 P30 SINGULAR PRESENTATION OF HEPATITIS B NATURAL HISTORY: PRES2 DELETION AND HCC IN THE WEST-AFRICA Sumantra Ghosh*, Nora K Deluce, Christhope Combet, Gibril Ndow2, Njie Ramou2, Yusuke Shimakawa3, Maud Lemoine4, Maimuna Mendy5, Mark Thursz4, Fabien Zoulim, Isabelle Chemin and PROLIFICA U052, INSERM, INSERM Lyon France, Lyon, France, 2MRC Gambia, Gambia, Gambia, The, 3Pasteur Institute, Paris, France, 4Imperial college London, London, United Kingdom, 5 Biobank, IARC Lyon, Lyon, France Corresponding author s sumantra.ghosh@inserm.fr Introduction: Hepatitis B virus (HBV) related cirrhosis and Hepatocellularcarcinoma (HCC) is endemic in Sub-Saharn Africa. PROLIFICA (EU-FP7#265994) aims to prevent HCC by treating HBV chronic carriers. Demographic data from PROLIFICA project suggest early (30-40 yr age) development of cirrhosis and HCC in Gambia. Aims: Therefore as a part of PROLIFICA we aim to evaluate the contribution of HBV genetic variability for progression of liver diseases in West Africa POSTERS ABSTRACTS Material and Methods: Population based screenings of HBV (serology) were done in field or in hospital on more than 6500 people. Quantification of HBV DNA, HBsAg and sequence based HBV genotyping on.4 kb PCR amplified full surface gene were sequenced directly or by cloning. Sequence alignments were performed to know the genotypes and mutational profile. Results: 0% HBsAg prevalence rate in the population with 95% are infected with HBeAg negative infection and low viral load (median 349 IU/ml). HBsAg quantification assay showed 75% of the individuals who have low viral load (<2000 IU/ml) had high HBsAg (>2000 IU/ml). 80% of them were genotype E and rest genotype A. 40% were carrying in frame deletion in a particular region of PreS2, subsequently affecting overlapping polymerase gene. These deletion mutants were significantly high on cirrhosis and HCC patients. 20% of the cases were failed in PCR based direct sequencing due to complex quasispecies pattern as explored by cloning. Presence of 2-4 types of pres deletion mutant were observed along with the wild type strain in same samples. 04 Programme & Abstracts Liver Disease in Resource Limited Settings

105 POSTERS ABSTRACTS Conslusions: Our data suggest that HBeAg negative hepatitis with very low viremia (<2000 IU/ml) and high HBsAg (>5000 IU/ml) and PreS2 deletion may be very important factor in Gambia for disease progression and HCC. Particularly our observation of high incidence of a particular pattern of PreS2 deletion on HCC and a complex quasispecies formation among treatment naive individuals may have direct or indirect influence in early progression to cirrhosis and HCC. Previous findings (S Urban et al., 200) suggest that this kind of deletion mutant is incapable of virus assembly. High levels of HBsAg in circulation may have direct implication in immune exhaustion and cytoplasmic stress in hepatocytes. Invitro studies and immunohistochemistry for HBV antigens in liver biopsies are ongoing to explore further. This study also highlighted the underestimated genetic complexity among the HBV genotype E strain and HBsAg quantification, not explored in this context. EASL Monothematic Conference Bucharest, Romania May 29-30,

106 P3 EFFICACY OF ENTECAVIR/TENOFOVIR FOR NUCLEOS(T) IDE-EXPERIENCED PATIENTS WITH CHRONIC HEPATITIS B IN REAL WORLD SETTING- EXPERIENCE FROM A TERTIARY CARE CENTER IN INDIA Sundeep K. Goyal*, Vinod K. DIXIT, Ashok K. JAIN, Jayant GHOSH Gastroenterology, Institute of Medical Sciences, Banaras Hindu University,VARANASI, India Corresponding author s drsundeepgoyal@gmail.com Introduction: In the treatment of chronic hepatitis B, antiviral resistance is still a challenging issue. Aims: The aim of this study was to determine the long-term outcomes of tenofovir/entecavir therapy in patients with prior nucleos(t)ide failure. POSTERS ABSTRACTS Material and Methods: We retrospectively analyzed HBV related cirrhotic patients with prior failure or resistance to nucleos(t)ide therapy and without access to liver transplantation, which were treated at University hospital s gastroenterology services. Patient with prior exposure to lamivudine (LAM) were treated with TDF 300 mg and to adifovir (ADV) were given entecavir 0.5 mg and exposed to both were treated with add on tenofovir with lamivudine. Results: : In all, 00 patients (median age 45 (3-65) years, 78 male, 39% hepatitis B e antigen [HBeAg]-positive), pretreatment consisted of monotherapy with LAM (n = 26), ADV (n = 9), and sequential LAM-ADV therapy (n = 35), or add-on combination therapy with both drugs (n = 30). 30 patients had one or more feature of decompensation at baseline. Baseline serum HBV DNA was 4.8log(0) IU/ML (range ) and median ALT was 78 IU/ ML (range 39-2). The overall cumulative proportion of patients achieving undetectable HBV DNA levels was 83% after median treatment duration of 23 months (range, 6-60). 69% patients achieved -point decrease in CTP score after 5 months (median, range 2665 months) of therapy. The 5-year cumulative rate of liver decompensation, hepatocellular carcinoma and cirrhosis related complications were 3.5%,.9% and 2.6% with annual incidence of 0.9%, 0.35% and.59% per person-year respectively. Conslusions: TDF/ETV induced a potent and long-lasting antiviral response and improve clinical course in NA-experienced patients with previous treatment failure. 06 Programme & Abstracts Liver Disease in Resource Limited Settings

107 P32 POSSIBILITY FOR ASSESSING HEPATIC FIBROSIS IN CHRONIC HEPATITIS C BY DETERMINING CYTOKINES Alevtina Shchekotova, Irina Bulatova, Vladimir Shchekotov*, Natalia Nasibullina and Svetlana Padutheva Department of Clinical Laboratory Diagnostics, Perm State Medical University, Пермь, Russia Corresponding author s al_shchekotova@mail.ru Introduction: To assess the severity of liver fibrosis in patients with chronic hepatitis C (CHC), in addition to biopsy, transient elastography (TE), biochemical patent hepatopanels, it is necessary to search for informative and less expensive tests, especially in conditions of limited resources. Aims: to study the possibility for diagnosing liver fibrosis using tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). Results: In the group of patients with the F-0 (n=26) age was 35 (3-44) years, the index of TE 4.9 ( ) kpa, HA 24 ( ) ng/ml, TNF-alpha.3 (0.6-.6) pg/ml, IL-6 0. (0-0.3) pg/ml. The age of patients with F-,2 (n = 45) was 36 (3-4) years, the value of TE 7. ( ) kpa, HA 49.6 ( ) ng/ml, TNF-alpha 4. (.5-7.8) pg/ml, IL (0-3.) pg/ml. The group with F-3.4 included 20 people 43.5 ( ) years, the index TE reached 8.4 ( ) kpa, HA 46.4 ( ) ng/ml, TNFalpha 9.7 ( ) pg/ml, IL ( ) pg/ml. Thus, in patients with F-,2, the concentration of HA was 2. times higher than its level with F-0 (p<0,002), at the same time, TNF-alpha content was 3.2-fold greater (p=0.00) and IL-6 three-fold (p=0.0). While comparing patients with severe fibrosis/cirrhosis (F3.4) and F-.2 the following results were obtained: the concentration of HA was 2.95 times higher than in patients with moderate fibrosis (p<0.000). TNF-alpha was 4,8-fold greater (p<0.000), IL fold (p<0.0004). Correlation analysis revealed a reliable positive relations between TE, HA, TNF-alpha and IL-6 values of parameters. These data confirm the influence of inflammatory process in the liver on the development of fibrosis. Conslusions: Increased production of not only HA, but of TNF-α and L-6 in CHC correlates with hepatic fibrosis progression. The studied cytokines can be used to stratify patients with no fibrosis from those with moderate and especially severe hepatic fibrosis/ cirrhosis. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: The study included 9 CHC patients: 42 men and 49 women. TE was performed using the device FibroScan-502 (Echosens, France), the stage of fibrosis was evaluated by means of Metavir scoring sistem. The direct fibrosis biomarker hyaluronic acid (HA) in blood serum was investigated with using ELISA kits BCM Diagnostics (USA), TNF-alpha and IL-6 were studied using VectorBest kits (Russia). Data are presented as ME (25-75%).

108 P33 POSSIBILITY FOR ASSESSING HEPATIC FIBROSIS IN CHRONIC HEPATITIS C BY DETERMINING CYTOKINES Alevtina Shchekotova, Irina Bulatova, Vladimir Shchekotov*, Natalia Nasibullina and Svetlana Padutheva Department of Clinical Laboratory Diagnostics, Perm State Medical Akademy, Perm, Russia Corresponding author s al_shchekotova@mail.ru Introduction: To assess the severity of liver fibrosis in patients with chronic hepatitis C (CHC), in addition to biopsy, transient elastography (TE), biochemical patent hepatopanels, it is necessary to search for informative and less expensive tests, especially in conditions of limited resources. Aims: To study the possibility for diagnosing liver fibrosis using tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). POSTERS ABSTRACTS Material and Methods: The study included 9 CHC patients: 42 men and 49 women. TE was performed using the device FibroScan-502 (Echosens, France), the stage of fibrosis was evaluated by means of Metavir scoring sistem. The direct fibrosis biomarker hyaluronic acid (HA) in blood serum was investigated with using ELISA kits BCM Diagnostics (USA), TNF-alpha and IL-6 were studied using VectorBest kits (Russia). Data are presented as ME (25-75%). Results: In the group of patients with the F-0 (n=26) age was 35 (3-44) years, the index of TE 4.9 ( ) kpa, HA 24 ( ) ng/ml, TNF-alpha.3 (0.6-.6) pg/ml, IL-6 0. (0-0.3) pg/ml. The age of patients with F-,2 (n = 45) was 36 (3-4) years, the value of TE 7. ( ) kpa, HA 49.6 ( ) ng/ml, TNF-alpha 4. (.5-7.8) pg/ml, IL (0-3.) pg/ml. The group with F-3.4 included 20 people 43.5 ( ) years, the index TE reached 8.4 ( ) kpa, HA 46.4 ( ) ng/ml, TNFalpha 9.7 ( ) pg/ml, IL ( ) pg/ml. Thus, in patients with F-,2, the concentration of HA was 2. times higher than its level with F-0 (p<0,002), at the same time, TNF-alpha content was 3.2-fold greater (p=0.00) and IL-6 three-fold (p=0.0). While comparing patients with severe fibrosis/cirrhosis (F3.4) and F-.2 the following results were obtained: the concentration of HA was 2.95 times higher than in patients with moderate fibrosis (p<0.000). TNF-alpha was 4,8-fold greater (p<0.000), IL fold (p<0.0004). Correlation analysis revealed a reliable positive relations between TE, HA, TNF-alpha and IL-6 values of parameters. These data confirm the influence of inflammatory process in the liver on the development of fibrosis. Conslusions: Increased production of not only HA, but of TNF-α and L-6 in CHC correlates with hepatic fibrosis progression. The studied cytokines can be used to stratify patients with no fibrosis from those with moderate and especially severe hepatic fibrosis/ cirrhosis. 08 Programme & Abstracts Liver Disease in Resource Limited Settings

109 P34 MICRORNAS DESREGULATION IN NONALCOHOLIC FIBROSING STEATOHEPATITIS Jinghua Du, Rongqi Wang, Yuemin Nan* Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China Corresponding author s dujinghua8608@26.com Introduction: Nonalcoholic fatty liver disease (NAFLD) is a multifactorial condition encompassing a wide spectrum of liver damage. MicroRNAs (mirnas) are an emerging class of non-coding small endogenous single-stranded RNA molecules that regulate gene expression at the post-transcription level. However, the mechanism of mirnas in the development and progression of nonalcoholic fibrosing steatohepatitis remains unclear. Aims: To clarify the role and molecular mechanism of hepatic mirnas in nonalcoholic fibrosing steatohepatitis in mice. Results: Microarray analysis identified 9 mirnas were up-regulated and 8 mirnas were down-regulated in the liver of mice fed MCD diet compared with the controls (FigA, B). High-enrichment GOs and KEGG signaling pathways contained Wnt signaling pathway. Luciferase activity assay confirmed that Wnt and Wnt5a were both the target genes of mir46a-5p. Hepatic mir-46a-5p was significantly down-regulated in MCD mice (FigC) and the target gene Wnt, Wnt5a and α-sma and Col- were up-regulated. The consistent changes were presented in the activated primary HSCs (FigC). Overexpression of mir46a-5p could inhibit cell proliferation of HSCs (FigD) and decreased the expression of Wnt, Wnt5a, α-sma and Col- (FigE). EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: Hepatic mirnas expression profile was analyzed in mice with nonalcoholic fibrosing steatohepatitis induced with methionine-choline deficient diet. Differentially regulated mirnas were subjected to GO and KEGG analysis. Luciferase activity assay was used to confirm the target gene of mir-46a-5p. The most significantly down-regulated mirna, the targets genes and downstream genes were measured by qrtpcr and western blot, respectively. The effect of the mirna on HSC proliferation was investigated by CCK-8.

110 Conslusions: The identified mirnas may provide a better understanding of the molecular basis of nonalcoholic fibrosing steatohepatitis. MiR-46a-5p probably modulated HSC activation in the progress of nonalcoholic fibrosing steatohepatitis through modulating targeted genes Wnt, Wnt5a and related signal transduction pathway. POSTERS ABSTRACTS Figure or Table: 0 Programme & Abstracts Liver Disease in Resource Limited Settings

111 P35 PLASMA LONG NON-CODING RNA-ATB IS ASSOCIATED WITH LIVER FIBROSIS PROGRESSION IN PATIENTS WITH CHRONIC HEPATITIS C Na Fu, Ping Meng, Xuemin Niu, Suxian Zhao, Yuguo Zhang, Rongqi Wang, Yuemin Nan* Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China Corresponding author s nanyuemin@63.com Introduction: Hepatitis C virus (HCV) infection is a growing public health problem, with roughly 3% of population infected worldwide. HCV related hepatic fibrosis is the key pathway to liver cirrhosis or hepatocellular carcinoma (HCC), which increase the risk of HCV patients. Recent studies showed that long non-coding RNAs (lncrnas) could regulate the progression of HCC, and overexpression of lncrna- activated by transforming growth factor beta (lncrna-atb) promoted the invasion-metastasis cascade in human HCC. However, the role of lncrna-atb in HCV related liver fibrosis is still unknown. Aims: To clarify the plasma level of lncrna-atb in HCV related hepatic fibrosis, and explore the relationship between lncrna-atb and liver fibrosis. Results: The plasma expressions of lncrna-atb were dramatically upregulation in HCV patients compared with that in the health control (Z=-5.76, P=0.000)(Fig. A), and were highly correlated with the stages of liver fibrosis (r=0.557, P=0.03)(Fig. B). The plasma expressions of lncrna-atb were markedly higher in HCV patients with moderate to severe fibrosis than that in patients with mild fibrosis (Z=-0.08, P=0.035)(Fig. C). The receiver operating characteristics analysis was used to evaluate the suitability of lncrnaatb expression to discriminate between mild fibrosis and moderate to severe fibrosis in HCV patients. EASL Monothematic Conference Bucharest, Romania May 29-30, 205 POSTERS ABSTRACTS Material and Methods: Thirty-one chronic HCV patients, twenty age and gender matched healthy subjects were enrolled from the Third Hospital of Hebei Medical University (Shijiazhuang, China). The stage of hepatic fibrosis was evaluated and divided into mild (F<2) and moderate to severe fibrosis (2 F<4) according to METAVIR scoring system. LncRNA-ATB expression was detected by real-time quantitative reverse transcription polymerase chain reaction (qrt-pcr).

112 Total area under the curve for lncrna-atb was 0.98 (P=0.000)(Fig. D), which suggested that lncrna-atb had adequate sensitivity and specificity to predict the degree of liver fibrosis in HCV patients. Conslusions: The plasma expression of lncrna-atb was increased and correlated with liver fibrosis stages in HCV patients. These findings indicate that lncrna-atb could be served as a novel biomarker for the diagnosis of HCV related hepatic fibrosis. POSTERS ABSTRACTS Figure or Table: 2 Programme & Abstracts Liver Disease in Resource Limited Settings

113 P36 MODULATION OF IL-23/TH7 AXIS INVOLVES IN CHRONIC HEPATITIS C VIRUS INFECTION Ping Meng, Xuemin Niu, Na Fu, Suxian Zhao, Rongqi Wang, Yuemin Nan* Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China Corresponding author s nanyuemin@63.com Introduction: Hepatitis C virus (HCV) remains a critical public healthy problem with approximately 80 million people infected worldwide. Th7 cells are characterized by the ability to secrete pro-inflammatory cytokines, such as IL-7A (also described as IL-7), IL-7F, IL-2, IL-22, IL-6 and TNF-α. IL-23 and its downstream factor IL-7 are key cytokines involved in immune and inflammatory response in chronic liver diseases. Aims: The aim of this study was to clarify the role, molecular mechanism of IL-23/Th7 axis in chronic hepatitis C (CHC). Results: The baseline plasma IL-23 levels and frequencies of IL-7A, IFN-γ-producing PBMCs were dramatically increased while IL-2-producing PBMCs were lower in CHC patients than those in healthy controls (P < 0.05, Fig. A, B). There were significantly higher PBMCs mrna expressions of IL-7A, IL-22, IFN-γ, STAT, MxA, SOCS3, GATA3 and FoxP3 in HCV infected patients than those in the healthy controls (P < 0.05, Fig. C, E, F, G, H, I). Additionally, in CHC patients, the mrna expression of IL-2, IFN-γ, STAT3, MxA and SOCS3 were apparently upregulated, while FoxP3 expressions were suppressed by administration of IL-23 agonist (P < 0.05, Fig. D, F, H, I). The contrary tendancies were observed in PBMCs treated with IL-23 antagonist. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: A total of sixty-six HCV infected patients and 20 healthy controls were enrolled. The baseline plasma IL-23 levels were assessed by ELISA. Frequencies of IL7A, IFN-γ, IL-2-producing PBMCs were determined by Flow Cytometry. PBMCs from 24 HCV patients and 5 healthy subjects were treated with IL-23 agonist or antagonist, and mrna expressions of IL-7A, IL-2, IL-22, IFN-γ, JAK, STAT, STAT3, IRF9, MxA, SOCS3, T-bet, GATA3 and FoxP3 were evaluated by qrt-pcr.

114 Conslusions: The IL-23/Th7 axis and their associated cytokines were increased or decreased during chronic HCV infection, so it is anticipated that targeting the IL-23 or Th7 cells could be effective therapeutics to prevent inflammatory damage. POSTERS ABSTRACTS Figure or Table: 4 Programme & Abstracts Liver Disease in Resource Limited Settings

115 P37 FIBROTOUCH IS SUPERIOR TO APRI AND FIB-4 FOR THE EVALUATION OF LIVER FIBROSIS IN PATIENTS WITH CHRONIC VIRAL HEPATITIS Rongqi Wang, Weiguang Ren, Suxian Zhao, Xuemin Niu, Jinghua Du, Huijuan Du, Yuemin Nan* Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China Corresponding author s nanyuemin@63.com Introduction: Liver fibrosis is an established determinant of prognosis and therapy in chronic liver disease. The role of transient elastography by FibroTouch in assessing fibrosis in chronic hepatitis B and C remains unclear. Aims: The aim of this study was to explore the clinical application and related factors of FibroTouch in the diagnosis of liver fibrosis in patients with chronic hepatitis B and C through comparison of the specificity and sensitivity of FibroTouch, AST-to-PLT ratio index (APRI) and fibrosis index based on the 4 factor (FIB-4), and to identify whether FibroTouch is a more accurate and safe method in diagnosis of liver fibrosis. Results: There was significant correlation between LSM and histological fibrosis (r = 0.76, P = 0.000). The area under ROC curve of LSM for S 2, S 3 and S=4 was 0.87, 0.93 and 0.98, respectively, which was significantly higher than APRI (0.66, 0.68 and 0.73) and FIB4 (0.73, 0.75 and 0.78). On Spearman analysis, LSM was correlated positively with age, ALT, AST, TBIL ( 2 ULN) and the grade of liver inflammation (r = 0.22, 0.52, 0.49, 0.54 and 0.62, respectively) but negatively with PLT (r = -0.40), (all P< 0.05). Conslusions: FibroTouch is a convenient and reliable noninvasive approach, which is superior to APRI and FIB-4, for diagnosis of liver fibrosis in patients with chronic viral hepatitis. High level of ALT, AST and TBIL ( 2 ULN) might be related with high LSM values measured by FibroTouch. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: A total of 46 patients with chronic hepatitis B and C were performed liver biopsy and underwent liver stiffness measurement (LSM) using FibroTouch (Wuxi Hisky Medical Technology Co Ltd) in department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University from January 204 to February 205. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) were tested by enzymic method with Olympus AU5400 Biochemistry Analyzer. Blood platelet counts were detected by automatic blood cell analyzer. APRI and FIB-4 were calculated. The diagnostic values of FibroTouch, APRI and FIB-4 for liver fibrosis degree were evaluated and compared by receiver operating characteristic (ROC) curves. The related factors of LSM were analyzed by Spearman analysis.

116 P38 EMPERIPOLESIS MEDIATED BY CD8+ T CELLS CORRELATED WITH BILIARY EPITHELIA CELL INJURY IN PRIMARY BILIARY CIRRHOSIS Suxian Zhao, Rongqi Wang, Yuguo Zhang, Huijuan Du, Xuemin Niu, Li Kong, Yuemin Nan* Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China Corresponding author s nanyuemin@63.com Introduction: Primary biliary cirrhosis (PBC) is thought to be an autoimmune disease characterized by chronic destruction of bile ducts. A major unanswered question regarding the pathogenesis of PBC is the precise mechanisms of small duct injury and destruction. Emperipolesis is one of cell-in-cell structures that have been observed in chronic viral hepatitis. However, it remains unknown whether emperipolesis is involved in biliary epithelia cell injury and it diagnostic value in PBC. Aims: To clarify the pathogenesis and histological characteristics of emperipolesis in the liver injury of PBC POSTERS ABSTRACTS Material and Methods: Sixty PBC patients, diagnosed by liver biopsy, were divided into two groups, early PBC (stages I and II, n=40) and late PBC (stages III and IV, n=20). The degrees of hepatic inflammation and fibrosis were assessed with Scheuer Scoring System. Emperipolesis was observed in liver sections stained with hematoxylin-eosin. The expression of CK9 (cholangiocyte), CD8 (T cell), CD20 (B cell), CD56 (NK cell), CD68 (macrophage cell) and MPO (neutrophil) was evaluated by mmunofluorescence double labeling combined with confocal microscopic observation. The apopotosis of BECs was detected by TUNEL assay under laser confocal microscope. Results: Emperipolesis was observed in 73.3% of patients with PBC, and BECs were predominantly host cells. In PBC patients with emperipolesis, the number of emperipolesis structures correlated with lymphoid follicles (r=0.4394, P<0.000), damage of bile ducts (r=0.295, P=0.003), proliferation of bile ducts (r=0.2860, P=0.0037) and inflammatory cells infiltration (r=0.2798, P=0.0046) in portal areas. In early stage of PBC, the entry of CD8+ T cells into BECs was observed and correlated with TUNEL positive BECs (r=0.468, P<0.005), but were not found in late stage. Conslusions: In early stage of PBC, emperipolesis mediated by CD8+ T cells appears to be relevant to apopotosis of BECs and further lead to the injury of interlobular bile ducts. 6 Programme & Abstracts Liver Disease in Resource Limited Settings

117 P39 HEPATITIS E VIRUS INFECTION IS ENDEMIC, BUT NOT A COMMON CAUSE OF ACUTE DECOMPENSATION OF LIVER CIRRHOSIS IN THE GAMBIA, WEST AFRICA Yusuke Shimakawa*, Harr F. Njai2, Kazuaki Takahashi3, Lauren Berg4, Gibril Ndow2, Adam Jeng2, Amie Ceesay2, Sheikh Mohammad Fazle Akbar3, Masahiro Arai3, Umberto D Alessandro2, Simon Taylor-Robinson5, Ramou Njie6, Mark Thursz5, Shunji Mishiro3, Maud Lemoine5 Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, Paris, France, 2MRC Unit, The Gambia, Banjul, Gambia, The, 3Department of Medical Scieneces, Toshiba Hospital, Tokyo, Japan, 4 Imperial College, London, London, United Kingdom, 5Department of Hepatology, Imperial College, London, 6MRC Unit, The Gambia, London, United Kingdom Corresponding author s kenkan555@hotmail.com Introduction: Although several sero-surveys in sub-saharan Africa suggested that the infection with hepatitis E virus (HEV) is endemic, the public health significance of HEV infection is poorly documented in the region. Material and Methods: Sera from: i) participants of hepatitis B virus (HBV) screening programme at the community and blood bank (general population); ii) patients with compensated cirrhosis; and iii) cirrhotic patients with newly developed jaundice, ascites or encephalopathy within four weeks (acute decompensated cirrhosis cases), were tested for anti-hev IgG using a commercialised enzyme immunoassay (Institute of Immunology, Tokyo, Japan) and HEV RNA using a nested polymerase chain reaction. A standardised epidemiological questionnaire was administered to the general population to identify risk factors for previous exposure to HEV. Results: In total, 269 people were assessed for HEV IgG and RNA: 204 from general population, 20 compensated cirrhosis and 45 acute decompensated cirrhosis cases. Median age was 37 years (range: 2-87) and 58.6% were men. The underlying causes of cirrhosis were: HBV (80.0%), HBV & hepatitis C virus (HCV) (4.6%), HCV (.5%), and unidentified (3.9%). EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Aims: We conducted a case-control study to examine the association between acute HEV infection and acute decompensation of liver cirrhosis within the PROLIFICA project (www. prolifica.eu) in The Gambia.

118 None was alcohol-related. Overall prevalence of anti-hev IgG was 4.9 % (95% CI:.9.7). Although the acute decompensated cirrhosis cases tended to have higher prevalence of IgG (24.4%) than general population (3.7%) and compensated cirrhosis (5.0%, p=0.08), none were found to have HEV RNA. After adjusting for age and sex, the following were associated with positive anti-hev IgG in the general population: being a non-muslim, a farmer, drinking water from wells, handling pigs and eating pork (Table). Conslusions: HEV infection is endemic in The Gambia. Sources of drinking water and exposure to pigs/pork were risk factors for previous exposure to HEV. However, none of the acute decompensated cirrhotic cases were HEV RNA positive. This in in contrast with numerous reports from Indian subcontinent suggesting that acute HEV infection is a common cause of a rapid decompensation of existing chronic liver disease. POSTERS ABSTRACTS Figure or Table: 8 Programme & Abstracts Liver Disease in Resource Limited Settings

119 P40 CLINICAL PREDICTIVE VALUE OF INSULIN SECRETION CHARACTERISTICS AND ABNORMAL GLUCOSE METABOLISM OF NAFLD PATIENTS Shang-Yu Chai*, 2, Chunjun Sheng, Xiaoyun Cheng, Peng Yang, Hong Li, Hui Sheng, Le Bu3, Wenjun Li3, Jiying Wang, Xiying Wang, Shen Qu2, 3 Endocrinology and metabolism, Shanghai 0th People s Hospital, 2School of Medicine, Tongji University, 3 Endocrinology and metabolism, Shanghai 0th People s Hospital, Shanghai, China Corresponding author s qushencn@hotmail.com Introduction: Hyperinsulinemia is a common metabolic characteristic of NAFLD. However, the mechanisms of hyperinsulinemia remain to be fully elucidated. Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) often coexist and have adverse outcomes. Aims: To observe the clinical characteristics of insulin secretion and glycometabolism in patients with NAFLD. Results: β-cell hypersecretion was significantly in the fat liver groups, even fat liver with T2DM compared with those in T2DM alone (HOMA2-B% P<0.005 and ΔI0 30min/ΔG0 30min P< 0.00). Insulin sensitivity were markedly decreased in fat liver patients, compared to those of normal control subjects (Matsuda index P<0.00 and HOMA2-S% P<0.0009). Slightly, but not significantly, lower in fat liver subjects with IGT or T2DM than those in IGT or T2DM alone. Hepatic insulin clearence was not lower in fat liver patients than nonfat liver patients with normoglycemia and IGT or T2DM alone (P>0.05). Linear regression analysis showed that ΔGlucose 0 20min was the best independent predictive variance (P=0.002). ΔGlucose 0 20min appeared to be the best diagnostic capacity of NAFLD with a c-statistic 0.90 (95% CI ) using ROC curve. EASL Monothematic Conference Bucharest, Romania May 29-30, POSTERS ABSTRACTS Material and Methods: 97 subjects with diagnosed NAFLD by magnetic resonance spectroscopy and 77 Waist circumference -and BMI matched subject were studied. Patients took a 75-g oral glucose tolerance test (OGTT), which measured serum insulin and C-peptide(C-p) levels at baseline (0 min), 30 min, 60 min, and 20 min after glucose challenge. They were classified further as normoglycemia, IGT or T2DM subgroups based on American Diabetes Association criteria. Hepatic insulin clearance, sensitivity and beta cell function were calculated using homeostasis and postprandial models.

120 Conslusions: Hyperinsulinemia is primarily caused by β-cell hypersecretion in fat liver patients with normoglycemia and IGT, even with T2DM controlled by glycemia-matched subjects, but not reduced hepatic insulin clearence. That give us the impression that NAFLD is not the result of insulin resistance but the complimentary effect of glucose dysregulation. Glycemia indexes such as ΔGlucose 0 20min appeared to be the best model to predict the severity of NAFLD than liver injury indices ALT,AST and γgt. The present study demonstrates pathophysiological differences in mechanisms of insulin resistance in patients with DM-NAFLD versus T2DM alone. POSTERS ABSTRACTS Figure or Table: 20 Programme & Abstracts Liver Disease in Resource Limited Settings