Today we spent time reviewing some highlights from AASLD San Francisco 2011. One particular abstract visited the age old question of HCV detectable, <43 IU/mL: is that any different than HCV undetectable? All cases of HCV GT 1 treated at this institution between 2008-2011 were reviewed retrospectively. Only 16 cases with complete follow up information were found to have at least one viral load detectable (but <43 IU/mL) during the treatment course. These were matched up to 31 controls without the detectable <43 IU/mL lab parameter.
The sustained virologic response rates for the control group were far superior (between 70-80%) to the study group (<15%), and thus, the breakthrough and relapse rates for the study group were much higher. The variable of cirrhosis trended towards statistical significance (p=0.09) as a risk factor for breakthrough or relapse. We concluded that this finding should be evaluated in a validation cohort to gain true significance.
The topic of NASH was also reviewed. To be sure, there were no treatment breakthroughs to report. The PNPLA3 gene, already known to be related to degrees of fibrosis and inflammation in alcoholic liver disease, was shown to correlate with degrees of steatosis. It is still unclear what role it plays in these pathways of pathology. There was a focus on testing non-invasive markers of disease severity; the FibroTest panel added to Fibroscan was one helpful way of excluding advanced fibrosis. On a more basic level, using the parameters of BMI, waist circumference, HDL and triglycerides was also shown to be modestly useful for predicting advanced fibrosis.
Join us again in two weeks time for AASLD Review Day #2 and we will cover new topics in hepatology.