There are patient-related as well as physician-related reasons for non-adherence to recommendations. Non-adherence affects clinical outcomes and can be avoided in selected cases.

Background: Hepatocellular carcinoma (HCC) is the fastest growing cancer in the United States. Studies have shown that compared to Blacks and non-Hispanic Whites, Hispanics have a higher HCC incidence and mortality rate. Most studies investigating HCC in Hispanics have been conducted utilizing data largely from the Western and Southern United States. These findings may, however, not be highly representative of Hispanics in the Northeast, given the nonhomogenous distribution and diversity of Hispanics across the United States.Methods: Some 148 HCC patients diagnosed between 1996 and 2012 were identified from a tertiary center in the northeastern United States. Hispanic patients were randomly matched to non-Hispanic White patients by year of diagnosis. Patient characteristics, HCC risk factors, treatment, and outcome were recorded. A Kaplan-Meier (KM) plot with log-rank tests was used for survival analysis.Results: Compared to non-Hispanic White patients (n=89), Hispanic HCC patients (n=59) were more likely to have chronic hepatitis C infection (69.5% vs. 38.2%, p < 0.01), alcoholic liver disease (37.3% vs. 21.4%, p = 0.04) and were less likely to have chronic hepatitis B infection (6.8% vs. 24.7%, p = 0.01), and private insurance (37.3% vs. 57.3%, p = 0.02). Hispanics were more likely to be diagnosed with an earlier stage disease (Barcelona Clinic Liver Cancer, BCLC stages A and B) compared to non-Hispanic patients (71.7% vs. 36.8%, p < 0.01) and were more likely to receive locoregional treatment. Although Hispanics trended towards improved overall survival, this finding did not hold when stratified by the BCLC stage. Conclusion:Risk factors for HCC in the northeastern Hispanic population are like those found among Hispanics in other US regions. Other research suggests Hispanics are at increased risk for hepatic injury and HCC. However, HCC in this northeastern Hispanic population appears to be less aggressive (earlier stage and trend towards better overall survival) than non-Hispanics. Further research may be needed to identify potential differences by ethnic group for HCC risk factors, presentation, and outcomes.

294 Background: In the U.S., Hispanics have a higher incidence of hepatocellular cancer (HCC) and higher disease-specific mortality. The country of origin for Hispanics varies throughout the U.S. However, little is known about Hispanics with HCC in the Northeast. We compared Hispanic and non-Hispanic patients with HCC at a Boston teaching hospital. Methods: Hispanic patients with HCC seen at Beth Israel Deaconess Medical Center (BIDMC) from 1998-2012 were identified in our database. Ethnicity was determined from demographic and language preference information in electronic medical records and supplemented by comparing surnames with the 1990 Census Spanish Surname List. The comparison group was identified by randomly choosing non-Hispanic patients diagnosed the same years as Hispanic patients. We compared both groups using Chi Squared test. Results: 59 Hispanic and 89 non-Hispanic patients with HCC were included in the analysis. The majority (48%) of Hispanic HCC patients were Puerto Rican. Although the median age at diagnosis was similar (59.1 vs 60.3 years for Hispanics and non-Hispanics), there were more women in the Hispanic cohort (28.8% vs 12.4% p0.012). Hispanics had greater odds of not having private insurance (OR 4.24, 95%CI: 2.101, 8.554). Evaluation of HCC risk factors revealed Hispanics were significantly more likely to have hepatitis C (OR 3.68, 95% CI: 1.830, 7.420). In addition, the incidence of Metabolic Syndrome was significantly higher for Hispanics (44.7% vs. 21.7% p0.025). Although individual components of metabolic syndrome were higher in Hispanics, they were not statistically significant: hypertension (52.5% vs 40.4%), Diabetes Mellitus (39% vs 25%), BMI ≥ 30 (39% vs 27%), hypertrigylceridemia (57% vs 52%) and low HDL levels (50% vs 41%). Hispanics were more likely to have received Transarterial Chemoembolization (TACE) and Radiofrequency ablation (RFA) treatments (OR 2.48, 95% CI: 1.261, 4.858). Conclusions: Hispanic HCC patients at BIDMC were more likely to have hepatitis C, metabolic syndrome and to be female than their non-Hispanic counterparts. Outreach to Hispanic communities to identify patients with hepatitis C and metabolic syndrome, particularly in women, may improve HCC prevention, screening and treatment outcomes.

Background: Identification of epidemiological particularities at patients with HIV/AIDS out of a specific geographic zone permits defining groups of risk for this disease, early diagnosis and applying the methods of prevention and prophylaxis.Methods: The authors have studied a group of 35 patients (male 20, female 15) adults, found in the evidence of the Department of Infectious Diseases Timisoara, residenced in 4 country departments, from western Romania. The positive diagnosis was based on epidemiological elements (type of sexual relationships, drug abuse, prostitution, etc.), clinical (prolonged fever syndrome, weight loss, polyadenopaty, oral candidiasis, etc.), biological (Ab HIV1-2 by ELISA test confirmed by western-blot, PCR viral loads, HBs Ag, Ab HCV, serological syphilis, etc.) and paraclinical methods (pulmonary radiography, abdominal ecography, CT, RMN, etc.). The data was registered and processed using the program Epi Info 6.Results: We mention that 21 patients (60%) were from urban medium and 14 (40%) from rural, aging between 18-36 years; 10 patients (28.57%) were married, 6 patients (17.41%) divorced, one (2.85%) remarried and 17 patients (48.57%) single; 28 patients (80%) had heterosexual relationships, including 26 (74.28%) with multiple partners; 2 men (5.71%) were homosexual; 4 women (11.42%) were prostitutes, including one iv. drug abuse; 3 patients (8.57%) had no sexual relationships; 2 patients (5.71%) were bisexual. We mention that none of the patients practiced safe sex. 5 patients (14.28%) were diagnosticated with syphilis; 6 patients (17.14%) with chronic hepatitis B and 3 (8.57%) with chronic hepatitis C; 26 subjects (74.28%) presented oral candidiasis; 3 patients (8.57%) with recidivating herpes zoster and 4 (11.42%) had recidivating acute pneumonia. 21 patients (60%) had average studies and 6 patients (17.14%) superior studies.Conclusions: The main way of transmitting HIV/AIDS remains the sexual contact. In the studied geographic zone, urgent preventing and prophylaxis methods of this disease are necessary.

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