Sunday, October 22, 2017

Video Series - NAFLD/NASH: Anticipating an impending storm

Video Series - NAFLD/NASH: Anticipating an impending storm

Part 1 - NASH: Anticipating an impending storm - What is NASH?
In this first part, Stephen A. Harrison, MD, Medical Director of Pinnacle Clinical Research, San Antonio, introduces us to NAFLD (Non Alcoholic Fatty Liver Disease), and more specifically NASH (Non-alcoholic Steatohepatitis). He explains the definition of the disease, as well as its characteristics & the risks induced by its progression. He also highlights how the disease is related to the double epidemic of obesity and diabetes.



Part 2 - Who is at risk?
In this second part, Mary E. Rinella, MD, Associate Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, describes in more detail who are the patients at risk of developing NAFLD (Non Alcoholic Fatty Liver Diseases)/NASH (Non-Alcoholic Steatohepatitis), the link between NASH and cardiovascular events, the ultimate consequences of the disease, and the importance of a multidisciplinary approach to be successful in the fight against NASH



Part 3 - Improving access to NASH diagnosis
In this third part, Pr. Arun J. Sanyal , MD, Virginia Commonwealth University Medical Center, Richmond, explains that NASH is under diagnosed because a biopsy is usually necessary to confirm diagnosis. Because NASH is a silent disease and most patients are asymptomatic until late stages of the disease, it is crucial that a new, easy-to-use, accessible non-invasive diagnostic tool becomes available soon.


Provided by: The NASH Education Program

Press Release 
October 20, 2017
The AASLD Meeting will also be an opportunity for The NASH Education Program™ to release the full length version of an educational video involving Drs. Stephen Harrison, Mary Rinella, Arun Sanyal, Kenneth Cusi and Vlad Ratziu, that was shot during NASHTAG 2017.

The NASH Education Program™: Key Insights from the First US Survey Commissioned by the NASH Global Health Observatory™
The NASH Education ProgramTM is an endowment fund created at the end of 2016 by the biopharmaceutical company GENFIT with the objective to conduct – together with other key stakeholders committed to the fight against nonalcoholic steatohepatitis (NASH) – a series of disease awareness initiatives around NASH. Today, it publishes new results from the first survey conducted in the US for the NASH Global Health Observatory.....
Download press release or Read Online
Detailed results will be shared during the AASLD Liver Meeting®

Updates From The Liver Meeting® 2017
The Liver Meeting® - Cardiovascular Risk in Women with Fatty Liver Disease: Risk is Not Equal Opportunity
The Liver Meeting® 2017 - Can you Inherit a Fatty Liver?
Fatty liver disease fastest-growing reason for transplants in young U.S. adults

Navigate This Blog 
The Liver Meeting® 2017

Patient-Friendly Links
HCV Sites With Key Data, Expert Review & Summary

The Liver Meeting® - HCV direct acting antivirals: Generics shown to be bioequivalent to originator brands

On Twitter - Shared By Henry E. Chang

Follow "Henry E. Chang" on Twitter to review clinical research and updates from The Liver Meeting® 2017; online via an easy to view sharing platform.
Andrew M. Hill1, Loai Tahat2, Mohammed Khalil Mohammed3, Sanjay Nath4, Rabab Fayez Tayyem3, James A. Freeman5, Ismahane Benbitour7, Sherine Helmy

Conclusion 


Read More - https://jumpshare.com/v/XoSYlogQfKnr4rVRcUnt

Navigate This Blog 
The Liver Meeting® 2017

Patient-Friendly Links
Clinical Clips Each Day Of The Meeting
‘What you need to know in 5-minutes’
HCV Sites With Key Data, Expert Review & Summary

Mark Sulkowski, MD Highlights Each Day From The Liver Meeting® 2017: What you need to know in 5-minutes


If you are a patient in search of easy to understand information click on this (LINK) for a collection of great HCV sites covering this years Liver Meeting. Click on this (LINK) for all updates on this blog.

Clinical Clips Each Day Of The Meeting - ‘What you need to know in 5-minutes’
Practice Point
Only takes a moment to register, starting Saturday.
Oct 22 - Mark Sulkowski, MD reviews 5 studies presented at the meeting
1- Access to treatment in the United States
2- Treatment for people with active or recent drug use
3- Treatment in Liver transplant patients HCV genotype 1 - 4
4- What happens after a patient is cured
5- SVR cohort of persons in clinical trials followed for up to 2.5 years, 12 weeks after treatment was found to be durable.
Start here - (LINK)

These educational Clinical Clips will spotlight the latest advances in the prevention and treatment of hepatitis C through a series of daily, ‘what you need to know in 5-minutes’ videos each day from The Liver Meeting® (AASLD)* 2017.
Hosted by Mark Sulkowski, MD
Professor of Medicine
Johns Hopkins University School of Medicine
Medical Director, Viral Hepatitis Center
Johns Hopkins Hospital
*Free registration may be required.
Follow on twitter

Liver Meeting 2017 - Liver Ca Transplant Rates Vary by Ethnicity

Updates On This Blog
The Liver Meeting® 2017

Liver Ca Transplant Rates Vary by Ethnicity
by Joyce Frieden Joyce Frieden, News Editor, MedPage Today
Blacks have lower rates despite same degree of illness, study finds

WASHINGTON -- African American patients at a major liver transplant center in the Midwest received liver transplantation less often than their white counterparts, even though they had about the same degree of illness, researchers said here.

In a 15-year cohort of liver cancer patients treated at two Indiana University clinics, 14% of African-American liver cancer patients underwent transplants compared with 26% of Caucasian patients (P=0.001), despite both groups having similar MELD (Model for End-Stage Liver Disease) scores, Child-Pugh scores, and BCLC (Barcelona Clinic Liver Cancer) staging, Lauren Nephew, MD, a transplant pathologist at Indiana University in Indianapolis, and colleagues said in a poster presentation at the annual meeting of the American Association for the Study of Liver Diseases.

Continue reading....

MedPage Today
Meeting Coverage > AASLD 

Saturday, October 21, 2017

The Liver Meeting® 2017 - Do all HCV Positive Liver Organs Carry Similar Risk of Transmission?

Updates On This Blog
The Liver Meeting® 2017

Do all HCV Positive Liver Organs Carry Similar Risk of Transmission?
Washington, D.C. – Use of liver organs from selected hepatitis C positive donors should be considered due to modest risk of hepatitis C transmission and the availability of safe and effective direct‐acting antiviral therapies, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

Hepatitis C virus, commonly called HCV, is a liver disease that can cause cirrhosis (scarring of the liver), liver cancer and liver failure. HCV is contracted when a person comes in contact with an infected person’s blood.

Given the ongoing shortage of liver grafts for transplantation, the use of increased‐risk donor livers (which are positive for HCV antibodies, but do not have evidence of active HCV infection) may be one way of increasing the donor pool and getting more patients off the waitlist. “While HCV‐positive donors (antibody test) with active infection (serum nucleic acid test positive) carry a universal risk of HCV transmission and their use is reserved for patients with active HCV on the transplant wait‐list, we hypothesized that HCV‐ positive donors without active infection will carry a much lower risk of HCV transmission. Liver organs from such donors, sometimes, can be discarded if an HCV positive patient is not available as a recipient. Our study was aimed at evaluating the risk of HCV transmission from such donors to non‐HCV patients on transplant waitlists,” says Khurram Bari, MD, assistant professor of Medicine at the University of Cincinnati.

Dr. Bari’s team studied a group of 25 patients at the University of Cincinnati who underwent liver transplantation between March 2016 and February 2017. These patients did not test positive for HCV at the time of transplantation. The livers they received during transplantation came from donors who tested positive for HCV antibodies and were labelled as HCV‐positive donors, but tested negative through HCV serum nucleic acid testing – suggesting no active infection. The majority of these donors were determined to be at increased risk for infection transmission by the Public Health Services’ (PHS) criteria based on donor characteristics.

All organ recipients underwent HCV testing three months post transplantation. Of the 25 people in the group, HCV transmission occurred in four (16 percent). Of the four, one recipient had a prior history with HCV/HIV co‐infection and had undergone a successful HCV treatment two years prior to transplantation. Three of the four recipients were treated with direct‐acting antiviral therapy (with one recipient completing 12 weeks of treatment and achieving a favorable outcome and the other two currently undergoing treatment and showing no signs of the virus at weeks two and four). The fourth recipient succumbed to complications brought on by pulmonary hypertension precluding treatment.

The researchers noted that while all donors were assessed to be at increased risk for transmission according to PHS’ criterion, the 16 percent rate of transmission was much higher than expected for the interval between infection and the appearance of mature virus in the serum – called the eclipse period. “Although our study did not look at the specific mode of HCV transmission, occult hepatitis C in donors could be one of the possible mechanisms” says Dr. Bari of the findings. “Our study, as a first ever, has estimated the actual risk of HCV transmission to non‐HCV patients from the use of liver grafts from serum HCV antibody positive, but nucleic acid test negative donors, “continues Dr. Bari. “Combined with the modest risk of transmission and positive response to DAA treatment, use of such organs could be considered to expand the donor pool. Future studies should be aimed at determining the exact mechanism of HCV transmission from such organs so that risk of transmission can be further reduced and widespread use of these organs can be made possible.”

Dr. Bari will present the study entitled “Risk of Hepatitis C Transmission from Antibody Positive‐Nucleic Acid Negative Liver Organs to Antibody Negative Recipients” on Sunday, October 22 at 8 AM in the Ballroom. The corresponding abstract (1) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® 2017 - ZEPATIER® High SVR In HCV Patients with Kidney disease

Real-World Study Shows ZEPATIER® (Elbasvir and Grazoprevir) Resulted in High Rates of Sustained Virologic Response in Patients with Chronic Hepatitis C Infection who have Chronic Kidney Disease

Observational Analysis Evaluated Patients in U.S. Veterans Affairs System

KENILWORTH, N.J., October 21, 2017 – Merck (NYSE: MRK), known as MSD outside of the United States and Canada, today announced the presentation of findings from a retrospective database analysis of patients with chronic hepatitis C virus (HCV) genotype (GT) 1 or 4 infection who have chronic kidney disease (CKD) and were treated with ZEPATIER® (elbasvir and grazoprevir) in the U.S. Department of Veterans Affairs (VA) healthcare system. Among patients who completed therapy, the analysis showed 95.6 percent (714/747) of patients with severe CKD (stages 4-5, defined as estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2) and 97.1 percent (758/781) of patients with moderate CKD (stage 3, defined as eGFR 30-59 mL/min/1.73 m2) achieved sustained virologic response (SVR), defined as HCV RNA below the limit of quantification at least 10-12 weeks after the end of treatment. For patients with missing HCV RNA data after at least 10-12 weeks after treatment completion, analyses were conducted on a post-hoc basis using the last HCV RNA data available after week 4 after therapy completion. The response rates in the real-world setting of the VA further supplement findings from controlled clinical studies of ZEPATIER.

These findings will be presented today at The Liver Meeting® 2017 taking place in Washington, D.C.

In the United States, ZEPATIER is indicated for the treatment of chronic HCV GT1 or GT4 infection in adults. ZEPATIER is indicated for use with ribavirin (RBV) in certain patient populations. The U.S. Prescribing Information for ZEPATIER includes a Boxed Warning about the risk of hepatitis B virus (HBV) reactivation in patients co-infected with HCV and HBV. In controlled clinical studies of ZEPATIER, SVR was the primary endpoint defined as HCV RNA less than lower limit of quantification at 12 weeks after the cessation of treatment (SVR12).

“These results demonstrate that U.S. veterans with chronic hepatitis C infection can achieve virologic cure in a real-world setting despite having co-morbid chronic kidney disease,” said Jennifer Kramer, investigator, Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center, Houston, Texas, and assistant professor of medicine, department of medicine, Baylor College of Medicine. “There is an ongoing need for an increased focus on screening and treating veterans and others who are disproportionately impacted by this disease.”

The retrospective observational analysis included 5,845 patients with chronic HCV infection who received ZEPATIER (elbasvir and grazoprevir) between February 1 and December 31, 2016. Patients were identified from the VA Corporate Data Warehouse, a national repository of VA electronic medical records. Presence of chronic kidney disease was measured via eGFR, per the National Kidney Foundation’s Modification of Diet in Renal Disease equation. Of 4,693 patients evaluated in the per protocol population, 16.6 percent (781/4693) had CKD stage 3 and 15.9 percent (747/4693) had CKD stages 4 or 5. Please see additional information below about the design, methodology and limitations of this observational analysis.

“Researching the needs of veterans is part of our collective responsibility to those who have served our country,” said Susan Shiff, senior vice president, Center for Observational and Real-World Evidence, Merck. “The robust nature of VA medical data enables us to study the effectiveness of ZEPATIER for the treatment of chronic hepatitis C infection in people with kidney disease and other comorbid conditions in that real-world setting.”

Adverse event data were not collected as part of this real-world data analysis.

Most patients with chronic kidney disease in the analysis were male (96.9%, 1481/1528); African American (67.5%, 1031/1528) and either had GT1a infection (52.2%, 798/1528) or GT1b infection (42.1%, 644/1528). The mean age for patients in the study with chronic kidney disease was 64.9 years. Comorbid conditions as defined by ICD-9/10 codes in the VA database included depression (58.5%, 894/1528), diabetes (69.2%, 1057/1528), compensated cirrhosis (18.6%, 284/1528), and HIV (5.0%, 76/1528). In the study, 19.9 percent of patients (304/1528) were coded as having decompensated cirrhosis; ZEPATIER is not for use in patients with moderate or severe hepatic impairment (Child Pugh B or C). See Selected Safety Information below for more information.

Study Methodology
The database included patients ages 18 and older with chronic HCV infection who initiated treatment with ZEPATIER between February 1, 2016, and December 31, 2016, and had at least one inpatient or outpatient visit within a year prior to treatment (n=5845). The study excluded patients without ≥2 eGFR values at least 90 days apart or on-treatment HCV RNA data, patients who did not receive 12-16 weeks of treatment with ZEPATIER and patients who received RBV >1 month after initiating treatment (n=1152).

SVR was defined in the protocol for these analyses as HCV RNA below the limit of quantification at least 10-12 weeks after the end of treatment. For patients with missing HCV RNA data at week 10-12 after treatment completion, analyses were conducted on a post-hoc basis using HCV RNA data captured starting from week 4 after therapy completion. SVR data at least 12 weeks after completion of therapy was available for 81.9% of the analysis population.

About Real-World Data Analyses and Associated Limitations
Real-world studies analyze data generated outside of randomized clinical trials, such as through analyses of electronic medical records or claims databases, to provide insight into how medicines perform or are used from a clinical and economic viewpoint in real-world clinical settings. Information from real-world analyses alone does not provide sufficient evidence to validate efficacy or safety of a therapeutic regimen and does not provide a substitute for evidence obtained from randomized controlled clinical trials.

This study is subject to certain limitations. The VA population may not be generalizable to the entire U.S. population, due in part to the potential for a differing demographic make-up and/or risk factors. Bias may exist as diagnoses and co-morbidities were identified through ICD-9/10 codes. Treatment completion was identified through prescription records which may not reflect adherence. Database analyses are also prone to errors in coding and missing data, including unavailable SVR data. Additionally, some laboratory data including data on the presence of baseline NS5A resistance associated substitutions was not available at the time of this analysis.

Liver Meeting 2017 - Patient-Friendly HCV Sites With Key Data, Expert Review & Summary

Greetings! For people new to the world of hepatitis C, the "Liver Meeting" can be a bit overwhelming, and difficult to navigate.

Like you, I will be spending time sifting through hepatitis C information presented at this years meeting. However, before I was cured in 2000, my search was more about key data pertaining to my own scenario; genotype, age, stage of liver damage, and cure rates. When I came upon a site with patient-friendly coverage, I was elated. Overjoyed. It made my journey so much easier.

You too? If so, make sure to read HCV Advocates November Newsletter when it comes out, and visit ViralEd after the meeting. On Nov 3rd, ViralEd will begin to launch expert commentary discussing all that great HCV data presented at the meeting, the program is titled; AASLD 2017 - Comprehensive Expert Review. In addition, watch a series of clips published each day from the meeting, starting Saturday over at Practice Point, hosted by Mark Sulkowski, MD.

Eventually, we will be reading full-text articles published in peer-reviewed journals, offering us more information about the impact of SVR on what I call the "Three L's" better known as; liver fibrosis, liver cancer, and liver-related complications. As they say knowledge is power.

Hot On Twitter
In order to find those full-text articles, follow "Henry E. Chang" on Twitter, he has already been tweeting from the meeting. Each day Mr. Chang tweets about viral hepatitis, pointing us to full-text articles using an online sharing platform. Incredible!

So, with that said, here is a collection of great web sites to get you started.

The Liver Meeting®, the Annual Meeting of the American Association for the Study of Liver Diseases.
October 20-24 2017 in Washington DC.

AASLD Links
Abstract supplement for The Liver Meeting® 2017
Oral Abstracts and Posters
AASLD - Website
Press Room
AASLD News
AASLD TV
YouTube
Follow On Twitter

Conference Coverage
NATAP
The National AIDS Treatment Advocacy Project - NATAP
Slide sets, press updates, commentary, and full-text articles. NATAP was one of the first web sites that offered so much information in one place.
Follow On Twitter

HIVandHepatitis.com
News, and commentary, another comprehensive web site that has been here since the beginning.
Follow On Twitter

Clinical Care Options
Review Capsule Summaries, download slides, and read Clinical Thought commentaries on key studies from Washington, DC 2017. I really hate to register with a web site, but in the end, CCO is so worth it.
*Free registration may be required.
Follow On Twitter

Healio
Coverage of the meeting will include, videos, perspectives and interviews with leading researchers and clinicians.
The coverage is exceptional, as is their monthly publication: HCV Next.
*Free registration may be required.
Follow On Twitter

Save The Date
ViralEd - Summary With Expert Review Beginning On November 3rd! Love it!

This program will feature HCV experts reviewing and discussing the most important studies on chronic hepatitis C presented at AASLD 2017. This review and discussion will provide a comprehensive overview of each of the posters and presentations as selected by our faculty panel. In addition, the faculty will provide unique insights into how knowledgeable experts review and analyze data from AASLD and an in-depth understanding of the scientific quality and clinical relevance of the posters and presentations reviewed.

This activity will enable participating health care providers caring for HCV-infected patients to become aware of and understand the data presented at this important conference and appropriately utilize those data to improve patient care.
Follow On Twitter


Clinical Clips Each Day Of The Meeting - ‘What you need to know in 5-minutes’
Practice Point 
Only takes a moment to register, starting Saturday.
Saturday Mark Sulkowski, MD reviews 5 studies presented at the meeting
1- Access to treatment in the United States
2- Treatment for people with active or recent drug use
3- Treatment in Liver transplant patients HCV genotype 1 - 4
4- What happens after a patient is cured
5- SVR cohort of persons in clinical trials followed for up to 2.5 years, 12 weeks after treatment was found to be durable.
Start here - (LINK)

These educational Clinical Clips will spotlight the latest advances in the prevention and treatment of hepatitis C through a series of daily, ‘what you need to know in 5-minutes’ videos each day from The Liver Meeting® (AASLD)* 2017.
Hosted by Mark Sulkowski, MD
Professor of Medicine
Johns Hopkins University School of Medicine
Medical Director, Viral Hepatitis Center
Johns Hopkins Hospital
*Free registration may be required.
Follow on twitter

HCV Advocate
HCV Advocates patient-friendly newsletter will include meeting coverage long after the meeting is over.
Newsletter; HCV Advocate
Patient-friendly coverage, easy to digest! Its better than chocolate.
Follow On Twitter 

Medscape
Commentary with news updates.
*Free registration may be required.
Follow On Twitter

MedPageToday
Also great commentary and news updates.
*Free registration may be required. 
Follow On Twitter

GI & Hepatology News
News and highlights
Follow On Twitter

On This Blog
Click this "LINK" to bring up current coverage, or click on the following topics:
Fibrosis
Cure Rates - SVR
High‐risk behavior - Drug Use
Fatty Liver
Herbal and dietary supplements

This article will remain current during and after the meeting, watch the sidebar of this blog for an updated link to this post.

Helpful Links
Twitter and Facebook, in addition to web sites, and blogs, that may also be covering the meeting.
Premier Hepatitis C Websites, Blogs and Support Forums

May you all remain healthy, wishing you a safe and successful journey.
Tina

The Liver Meeting 2017 - Tenofovir exalidex safe, well-tolerated in early HBV trial

Tenofovir exalidex safe, well-tolerated in early HBV trial
October 21, 2017
Tenofovir exalidex, a novel prodrug of tenofovir, appeared safe and well-tolerated in patients with hepatitis B, according to a presentation at The Liver Meeting 2017.

“The final results from this study have confirmed a clear way forward for developing TXL so that it can become a key component of future, successful combination treatments for HBV infection,” Tawesak Tanwandee, MD, associate professor of medicine and head of the division of gastroenterology in the department of medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand, told Healio.com/Hepatology. “This is important for patients, and those who treat them, because we need to have many treatment choices for this widespread, and complicated, disease.”


Coverage At Healio

Editorial: hepatitis C virus (HCV) disease progression – HCV cure and the elimination of the “ethnic slope”

November 2017 Volume 46, Issue 10 Pages 911–1028

INVITED EDITORIALS
Editorial: hepatitis C virus (HCV) disease progression – HCV cure and the elimination of the “ethnic slope”
Tau, S. C. Pappas

First published: 20 October 2017
DOI: 10.1111/apt.14283

Abstract
Linked Content
This article is linked to Le et al papers.

Ethnic disparities in health outcomes demand attention and explanation, as they themselves are plights to be abolished. We read with great interest the study by Le et al., which confirms that ethnic disparities exist in hepatitis C virus (HCV)-related liver disease progression and overall survival, and suggests that achieving SVR abolishes the ethnic disparities.[1] But what is the root cause of apparent baseline disparities—biology or bias in observation?

Imagine HCV as a ball rolling down different “ethnic slopes,” each representing different rates of progression to, and of, cirrhosis. Does HCV progress more rapidly in Hispanics and Asians, or are they simply presenting later in their disease course? Is it possible the balls started down the same slope but at different times?

If Asian and Hispanic patients had been infected significantly earlier than White and African American patients, their outcomes at baseline and follow-up would be worse. In this study, Asians had fewer co morbidities, and Asians and Hispanics tend to be immigrants. Both are thus presumably less likely to seek or have access to care and be diagnosed. The progression to, and of, cirrhosis seems susceptible to this bias of earlier infection as Lu et al. recognise but unfortunately were unable to study.

There is another hypothesis: racial disparities in fact exist, both before and after SVR (the balls roll on at different slopes, albeit slower), but the SVR cohort is, by nature of treatment selection, for example with interferon, a selectively healthier and smaller cohort, potentially reducing the ability to detect a difference in outcomes between ethnicities when there may be one. Furthermore, by definition, a patient in the SVR cohort could not have died or developed cirrhosis or HCC before achieving SVR, or else he would be excluded in the analysis of that outcome (immortal time bias).[2] Thus, the authors may have selected for HCV patients who are earlier in their disease and the time to detect differences in progression to cirrhosis or HCC is prolonged and not captured by the study—irrespective of achieving SVR. It would be important to see if ethnic disparity remains specifically in the cohort who were treated but did not achieve SVR, excluding those subjects with SVR and subjects not treated. If, in this cohort, ethnic disparities are abolished, then the authors’ hypothesis that abolition of disparities is related to achieving SVR is contradicted.

While further studies are needed to confirm the findings of Lu et al., it is quite plausible that once SVR is achieved, poor outcomes are delayed or stopped equally in all races. Once one removes the ball altogether (SVR), why does the slope downward matter? The force driving disease progression is eliminated. Indeed, studies show that curing HCV halts, or at least slows down, progression of liver disease.[3, 4] So cure may be colour blind, but is disease? The question matters in healthcare settings where triaging patients is warranted due to the expense of HCV anti-viral medications. A controversial implication is that if HCV behaves biologically differently among different ethnicities, then prioritisation should be a function of ethnicity. However, if it were simply that Hispanics and Asians present later in their disease, then the focus should be early diagnosis by expanding access to care.

Le et al. are to be commended for bringing our attention back to ethnic disparities in HCV-related outcomes and providing data that suggests SVR eliminates these disparities. As the populations of the United States and Canada or other countries swing to an ethnic mix of increasing Hispanic and Asian populations, further understanding of the cause of the disparities is key to developing diagnostic and treatment strategies to abolish them.
Editorial: hepatitis C virus (HCV) disease progression – HCV cure and the elimination of the “ethnic slope”
K. Le,G. Garcia,M. H. Nguyen
First published: 20 October 2017
We thank Drs. Tau and Pappas for their insightful comments on our paper.[1, 2] We agree that understanding the cause of ethnic disparities in health outcomes is crucial in developing strategies to effectively eliminate them.

While it remains to be seen whether there is a biological component to the increased risk for advanced liver disease observed in Hispanic and Asian patients in our study, there have been studies that have called to attention the barriers to care that impact ethnic minorities with chronic hepatitis C.

For Asian and Hispanic immigrant groups in particular, acculturation plays a major role in modifying behavioural, social and health characteristics of immigrants which lead to a decline in health over time.[3] Immigrants have higher unemployment and poverty rates and lower rates of health insurance coverage, especially in Hispanic and Southeast Asian groups.[4] Furthermore, in a recent population based study, Vutien et al found racial minority status to be independently associated with not receiving anti-viral treatment for chronic hepatitis C even after adjustment for socioeconomic status and medical/psychiatric comorbidities, indicating that additional ethnicity-related factors affecting treatment rates were present.[5] Therefore, while earlier age of infection in Hispanic and Asian patients may be a contributing factor to the disparities in disease progression observed in our study, there are additional socioeconomic, cultural and insurance barriers that exist for minorities which further exacerbate the disparity and should be addressed.

To address concerns over immortal time bias, we conducted further analysis on the patients who received treatment but did not achieve SVR. There continued to be significant differences in the 10-year cumulative incidence of cirrhosis among the ethnic groups with Hispanics (75.6%) and Asians (70.8%) having the highest incidence, followed by African Americans (54.6%) and Caucasians (53.6%) (log-rank test P-value: .0025). On multivariate analysis (Table 1), Hispanic patients in this group had a 52% increased risk of developing cirrhosis (adjusted HR 1.52, CI 1.09-2.12, = .014) compared to Caucasians. Significant differences also continued to persist in 10-year cumulative HCC incidence with Asians (36.3%) having the highest incidence, followed by Hispanics (29.7%), Caucasians (19.2%) and lowest in African Americans (13.4%). Asians in this group had a 63% increased risk (adjusted HR 1.63, CI 1.04-2.54, = .032) of HCC compared to Caucasians. Overall, ethnic disparities persisted in patients who received treatment but failed to achieve SVR. These findings confirm our conclusion that the abolition of ethnic disparities is related to achieving SVR.

Table 1. Cox proportional hazards regression analyses for progression to cirrhosis and HCC in patients who have received anti-viral therapy but did not achieve SVR


Unadjusted HR (95% CI)P-valueAdjusted HR (95% CI)P-value
  1. HR, hazard ratio; CI, confidence interval; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; MELD, model for end-stage liver disease.
A. Cirrhosis
Ethnicity
Caucasian1 (Referent)1 (Referent)
Hispanic1.61 (1.21-2.14).0011.52 (1.09-2.12).014
Asian1.58 (1.09-2.29).0161.25 (0.81-1.92).32
African American1.07 (0.65-1.77).781.52 (1.09-2.12).97
Age (5-yr intervals)1.20 (1.12-1.27) <.0011.15 (1.07-1.24) <.001
Male1.07 (0.85-1.35).571.02 (0.78-1.34).9
Diabetes1.63 (1.28-2.09) <.0011.21 (0.90-1.63).21
HBV coinfection1.45 (0.90-2.34).131.26 (0.73-2.19).41
Albumin0.77 (0.63-0.94).0120.92 (0.74-1.15).45
Platelets0.993 (0.992-0.995) <.0010.995 (0.993-0.997) <.001
B. HCC
Ethnicity
Caucasian1 (Referent)1 (Referent)
Hispanic1.38 (0.97-1.96).071.37 (0.93-2.03).11
Asian2.44 (1.67-3.57) <.0011.63 (1.04-2.54).032
African American0.97 (0.47-2.00).940.99 (0.43-2.31).99
Age (5-yr intervals)1.39 (1.29-1.51) <.0011.39 (1.25-1.54) <.001
Male2.50 (1.80-3.49) <.0012.61 (1.78-3.81) <.001
Diabetes2.61 (1.96-3.47) <.0011.52 (1.10-2.11).012
HBV coinfection2.30 (1.36-3.90).0021.74 (0.93-3.27).083
Cirrhosis20.21 (8.31-49.14) <.00111.10 (3.52-35.03) <.001
MELD1.03 (1.01-1.05).0021.01 (0.98-1.03).54

We believe the root cause of ethnic disparities in HCV disease progression is multifactorial and can include longer duration of infection and poorer linkage to care besides potential unknown race-specific genetic factors. However, whether the ball is rolling down the same “ethnic slope” at different times or different “ethnic slopes” at the same time, it appears that once the “ball” (the disease driving force) is removed (by SVR), the slope downward no longer matters. The results should encourage and drive additional efforts in early screening, diagnosis and linkage to appropriate care of chronic hepatitis C patients of all ethnic backgrounds.
http://onlinelibrary.wiley.com/doi/10.1111/apt.14326/full

Friday, October 20, 2017

The Liver Meeting® - One Liver. Two Saved Lives.

Updates On This Blog
The Liver Meeting® 2017

One Liver. Two Saved Lives.
Increasing split liver transplantation could help children get transplanted faster, without decreasing access for adult patients

WASHINGTON – A new study presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases — found that increased utilization of split liver transplantation (sharing a donor liver between one pediatric and one adult patient) could decrease the number of children who die awaiting liver transplantation without decreasing liver transplantation access for adult patients.

The study, sponsored by the University of California San Francisco, investigated the impact that increasing use of split liver transplantation might have on pediatric waitlist deaths in the United States by comparing the number of organs that might be ‘split‐able’ to the number of children who die on the waiting list.

“Among children listed for liver transplant in the United States, more than one in 10 infants and one in 20 older children die while waiting for a liver,” says Emily Perito, MD; assistant professor of pediatrics, at the University of California, San Francisco, and lead investigator in the study. “At many hospitals, children risk a long, life‐threatening wait for liver transplant, and they often receive a segment of an adult’s liver. The other portion can be used for an adult transplant, so we are able to save two lives with one organ.”

Dr. Perito’s team utilized United Network of Organ Sharing Standard Transplant Analysis and Research data to examine the number and geographic distribution of livers that might have been used for split liver transplant. In the United Kingdom, she notes, defaulting to split transplantation virtually eliminated pediatric waitlist deaths. But, by comparison, less than two percent of deceased donor livers are split in the U.S.

The researchers identified potentially split‐able livers deceased donor livers that were transplanted from 2010 to 2015 and fit the following strict criteria: 18 to 40 years of age, not overweight, recovered in the

U.S. after donor brain death, not high‐risk for transmissible infections based on CDC criteria, with normal sodium levels and liver function, no viral hepatitis or bloodstream infection, minimal fat in the liver, stable cardiovascular status and hospitalization less than seven days.

Livers that were primarily allocated to patients who would have been high‐risk for split liver transplantation were removed from the study. These patients had life‐threatening liver failure, required re‐transplantation, were in the hospital’s intensive care unit, had a body mass index over 34, or who were greater than 300 miles from the donor hospital.

Finally, for the purposes of the study, the researchers defined pediatric waitlist deaths as deaths and removals of patients who were too sick to transplant and never relisted.

Out of 35,461 livers transplanted from 2010 to 2015, the researchers found that 6.7 percent were potentially useable for split liver transplantation based on their donor characteristics. Of these, only five percent were split for transplant into two patients. Of the 95 percent that were transplanted as whole livers, 50 percent went to recipients who were deemed high‐risk for split liver transplantation; receiving the whole liver was potentially important for these patients’ safety. This left 1,116 potential livers for split transplantation. Of those, 78 percent of their primary recipients were listed as willing to accept a split liver donation, and 97 percent were willing to accept a liver that had six or more hours between donor and recipient, which allows time for the surgical splitting of the liver.

During this same five‐year period, 261 children died after three or more days on the transplant waitlist. Of these 261 children, 56 percent were less than two years old, 26 percent were two to 12 years old, and 18 percent were between 13 and 18. Their median weight was 20 pounds. The study found that 36 percent of these children died at transplant centers that did no pediatric split liver transplantations or averaged one or fewer per year.

Based on these findings, the researchers concluded that increased utilization of split liver transplantation could decrease pediatric waitlist mortality in the U.S. without decreasing liver transplantation access for adults. They also noted increasing the number of centers with splitting experience, and the possibility of splitting on normothermic perfusion could help.

“Our analysis suggests that increasing split liver transplantations has the potential to save lives, by getting both adults and children to transplant faster,” explains Dr. Perito. “Barriers are significant — including technical complexity and coordination of multiple transplant teams — but the potential benefit is fewer deaths while on the waitlist. We hope that this work encourages efforts to expand the role of split liver transplantation in the U.S.”

Dr. Perito will present these findings at AASLD’s press conference on Saturday, October 21 at 4 PM in room 103B at the Walter E. Washington Convention Center in Washington, D.C. The study entitled “Increasing split liver transplantation in the U.S. could decrease pediatric deaths on the liver transplant waiting list” will be presented Sunday, October 22 at 5:45 PM in Room 150. The corresponding abstract (137) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® - Direct‐Acting Antiviral Therapy Cuts Liver Cancer Risk By 71%

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The Liver Meeting® 2017

Direct‐Acting Antiviral Therapy Cuts Liver Cancer Risk By 71%
WASHINGTON – A new study presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases — found that eradication of the hepatitis C virus induced by direct‐acting antiviral medications is associated with a 71 percent reduction in the risk of liver cancer.

Hepatitis C virus, commonly called HCV, is one of several viruses that can infect the liver. According to the Centers for Disease Control and Prevention, approximately 2.7 million people in the United States are infected with HCV. And, HCV along with chronic hepatitis B virus infections account for approximately 78 percent of all liver cancer cases worldwide.

Researchers at the University of Washington, Seattle and the Veterans Affairs Puget Sound Healthcare System in Seattle recently conducted a study to determine whether the eradication of HCV with direct‐ acting antivirals — used to stop the lifecycle of HCV — could reduce liver cancer risk in patients.

To date, it has been unclear whether eradicating HCV through DAA treatment (referred to as sustained virological response) reduced the risk of liver cancer in patients infected with HCV. The researchers of this study also sought to compare the response to DAA regimens and interferon‐based regimens. The researchers repeated and extended their analysis to June 2017 in order to identify more incident cancers, especially in the DAA‐only treatment group.

“The majority of primary liver cancers in the United States occur in patients with hepatitis C virus infection. It is tempting to assume that if we eradicate hepatitis C, the risk of liver cancer will also be eradicated or at least substantially reduced,” says George N. Ioannou, MD, MS, associate professor of gastroenterology at the University of Washington School of Medicine, and lead investigator in the study.

“However, patients with hepatitis C may already have developed cirrhosis or advanced fibrosis before the hepatitis C is eradicated, which may put them at risk of liver cancer even after hepatitis C is eradicated. Furthermore, recent studies suggested an increased risk of liver cancer in patients with HCV who were treated with the new DAAs. This made it all the more imperative for us to determine whether DAA‐induced eradication of HCV is associated with a reduction in liver cancer risk using an adequately powered study,” he says.

The researchers identified 62,051 patients who underwent 83,695 antiviral treatment regimens in the VA Puget Sound Healthcare System from 1999 to 2015. The data included 35,873 interferon‐only regimens, 26,178 DAA±interferon regimens and 21,644 DAA‐only regimens. They used Cox proportional hazards regression to determine the association between HCV eradication and liver cancer risk after adjusting for a large number of potential confounders.

Dr. Ioannou’s team identified 3,271 incident cases of liver cancer diagnosed at least 180 days after initiation of antiviral treatment during an average follow‐up of 6.1 years. The incidence of liver cancer was highest in patients with cirrhosis and treatment failure (3.25 per 100 patient‐years), followed by cirrhosis and sustained virological response (1.97), no cirrhosis and treatment failure (0.87) and no cirrhosis and sustained virological response (0.24). Sustained virological response was associated with a significantly decreased risk of liver cancer in multivariable models regardless of whether the antiviral treatment was DAA‐only (adjusted hazard ratio [AHR] 0.29, 95% CI 0.23‐0.37), DAA+interferon (AHR 0.48, 95% CI 0.32‐0.73) or interferon‐only (AHR 0.32, 95% CI 0.28‐0.37). Receipt of a DAA‐only or DAA+interferon regimen was not associated with increased HCC risk compared to receipt of an interferon‐only regimen.

The study’s findings showed that DAA‐induced sustained virological response is associated with a 71 percent reduction in patients’ liver cancer risk, and showed treatment with DAAs is not associated with increased liver cancer risk compared to treatment with interferon.

“Eradicating hepatitis C will have a tremendous benefit in reducing liver cancer in individual patients and in the entire population,” says Dr. Ioannou. “Physicians and patients should not be withholding antiviral treatment for fear of inducing liver cancer. On the contrary, physicians should be treating hepatitis C specifically to reduce the risk of liver cancer.”

Editor’s Note: Dr. Ioannou will be presenting updated findings at The Liver Meeting®. This release reflects the updated data that will be presented.

Dr. Ioannou will present these findings at AASLD’s press conference in Room 103B at the Walter E. Washington Convention Center in Washington, D.C., on Saturday, October 21 at 4 PM. Dr. Ioannou will present the study entitled “Eradication of HCV induced by direct‐acting antivirals is associated with a 79% reduction in HCC risk” on Monday, October 23 at 8:45 AM ET in the Ballroom. The corresponding abstract (142) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® - Deaths Rates of Liver Cirrhosis Exceed Those of 5 Major Cancers

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The Liver Meeting® 2017

Deaths Rates of Liver Cirrhosis Exceed Those of 5 Major Cancers
Korean study compares cirrhosis to lung, colorectal, stomach, liver and breast cancers

WASHINGTON – A new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that liver cirrhosis mortality is greater than that of five major cancers, implying the development of appropriate interventions to treat or prevent liver cirrhosis must be prioritized.

The study, sponsored by the Korean Association for the Study of the Liver and the Korean Liver Foundation, was conducted in response to the low survival rate of liver cirrhosis patients and the need to design improved health policy regarding this condition. The researchers, from the Republic of Korea, estimated the mortality of liver cirrhosis and compared it to that of five major cancers: lung, colorectal, stomach, liver and breast.

“Accurate data regarding the burden of diseases are necessary to inform health care policy, prioritize appropriate research and interventions, and allocate resources,” says Dong Joon Kim, MD, PhD; chair, Division of Gastroenterology and Hepatology at Hallym University College of Medicine, and a corresponding investigator in the study.

According to Dr. Kim, mortality rates differ between high‐ and low‐income countries for liver cirrhosis and cancers of the lung, liver, stomach, colorectal and breast, but are substantial worldwide. “Liver cirrhosis causes 1.2 million deaths yearly worldwide, ranking as the 14th and 10th leading cause of death in the world and in most developed countries, respectively. To compare the burden of one disease with that of another, it’s necessary to consider the age at death, the life expectancy of people affected by each disease, and the degree of disability that each condition imposes on those who live with the disease. Different metrics – such as deaths, years of life lost, and years lived with disability – highlight different aspects of a population’s health status, and survival may be the most important of those,” says Dr. Kim.

The researchers studied nationally representative mortality across all of these diseases using data from both the Cause of Death Statistics and National Health Insurance Service‐National Sample Cohort (NHIS‐ NSC) databases. NHIS‐NSC provides a cohort data of 1,025,340 patient‐representative sample for the 46,605,433 population of Korea from 2002 to 2010. Liver cirrhosis was carefully defined using ICD‐10 codes, and eight‐year mortality from 2002 to 2010 was compared with that of the cancers (also defined using ICD‐10 codes).

According to the NHIS‐NSC data, 800 out of 2,609 liver cirrhosis patients in 2002 died during the following eight years, while 1,316 out of 4,852 of the patients with the five major cancers also died during this period. The relative mortality of liver cirrhosis in comparison to the five cancers studied was greater after adjusting for age, gender, area of residence, type of insurance, insurance premium level (a proxy for income level) and co‐existing diseases and conditions.

The researchers then used sensitive analysis to check the robustness of the results, excluding patients with both liver cirrhosis and any of the five cancers. Relative mortality for liver cirrhosis was still greater even when mortality‐related factors were adjusted for, says Dr. Kim. In another analysis of the data, the researchers limited the patients with liver cirrhosis to those with decompensated liver cirrhosis, and found that relative mortality for this condition was even greater when compared to the five cancers.

“More importantly, 70.9 percent of liver cirrhosis patients died before the age of 65, while 54.6 percent of the patients with the five cancers studied died after the age of 65 years. Therefore, the socioeconomic burden of liver cirrhosis outweighs that of cancers. This finding might help to adequately allocate health resources and the proper implementation of health policies,” says Dr. Kim.

While liver cirrhosis survival rates were known to be low, few studies have compared them to other major diseases, says Dr. Kim, noting “the socioeconomic impacts could be greater when considering that more males and younger patients are subject to death from liver cirrhosis than from cancers. This implies that we need to prioritize the development of appropriate health interventions for liver cirrhosis just as we have done for cancer.”

The study entitled “Liver cirrhosis and cancer: comparison of mortality” will be presented by Dr. Kim at the Walter E. Washington Convention Center in Washington, D.C. on Monday, October 23 at 10:30 AM ET in Room 151. The corresponding abstract (171) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® - Cardiovascular Risk in Women with Fatty Liver Disease: Risk is Not Equal Opportunity

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The Liver Meeting® 2017

Cardiovascular Risk in Women with Fatty Liver Disease: Risk is Not Equal Opportunity

Washington, D.C. – Nonalcoholic fatty liver disease is associated with significantly higher risk of subsequent cardiovascular events in women, but not in men, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

Nonalcoholic fatty liver disease, commonly called NAFLD, is a group of diseases characterized by an excessive accumulation of fat in the liver, and most often occurring in people who consume little to no alcohol. NAFLD is the most common form of chronic liver disease in children and adults, affecting 80 to 100 million people around the world.

NAFLD has been recognized as a risk factor for cardiovascular incidents – such as heart pain, heart attack, heart failure, irregular and rapid heartbeat and stroke. Cardiovascular disease is generally known to occur less in women, simply because of their female sex. This made researchers at Mayo Clinic in Rochester, Minn. interested in exploring if sex‐related differences in cardiovascular events persist in patients with NAFLD.

Alina M. Allen, MD, assistant professor of Medicine at the Mayo Clinic’s Division of Gastroenterology and Hepatology, and her team compared 3,869 people who were diagnosed with NAFLD between 1997 and 2014 to 15,209 people without the disease (all of which lived in the same community and were matched based on age, gender and pre‐existing cardiovascular diseases).

“We followed this cohort for up to 20 years and examined the number of new cardiovascular events that occurred in men and women after NAFLD diagnosis and their matched counterparts,” explains Dr. Allen. “We noted that in subjects with NAFLD, the risk for these events was higher in women than in men, but contrary to those without the liver disease. In NAFLD, the protective effect of the female sex on cardiovascular risk disappears. Additionally, we noted cardiovascular events started at an earlier age for these women than in the general population.”

These findings suggest that cardiovascular risk assessment in NAFLD should consider sex‐related differences, as women may require more aggressive preventative measures to avoid worse cardiovascular outcomes.

Future studies should assess preventative measures that could lower this risk.

Dr. Allen will present these findings at AASLD’s press conference in Room 103B at Walter E. Washington Convention Center in Washington, DC on Saturday, October 21 at 4 PM. Dr. Allen will present the study entitled “Cardiovascular Risk in NAFLD – Not an Equal Opportunity: Implications for Women’s Health” on Sunday, October 22 at 5:45 PM in room 150. The corresponding abstract (55) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® 2017 - Can you Inherit a Fatty Liver?

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The Liver Meeting® 2017


Can you Inherit a Fatty Liver?
Heritability of serum metabolites associated with Fatty Liver

Washington, D.C. – Serum metabolites associated with nonalcoholic fatty liver disease may be heritable, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

Nonalcoholic fatty liver disease, commonly called NAFLD, is a group of liver diseases characterized by an excessive accumulation of fat in the liver, usually occurring in patients who consume little to no alcohol. It is the most common chronic liver disease in children and adults, affecting 80 to 100 million people worldwide.

Studies have shown that NAFLD is heritable and has a shared genetic risk factor for metabolic syndrome, which is a group of medical conditions (e.g., high blood pressure, high blood sugar, high cholesterol) that can lead to serious diseases and conditions, such as heart disease and diabetes. Serum metabolite is the small molecule intermediate product of a metabolic reaction that can be detected in serum extracted from coagulated blood. By studying serum metabolites, investigators can identify which metabolic reactions or pathways have been altered in a disease. While several serum metabolites are known to be associated with NAFLD, they have not been assessed for heritability.

To address this, researchers led by Rohit Loomba, MD, director of the NAFLD Research Center at the University of California, San Diego conducted a study to investigate whether heritability exists in serum metabolites associated with NAFLD and if there are any shared genetic effects. Cyrielle Caussy, MD, PhD, an endocrinologist from Lyon 1 University and a visiting scholar at the NAFLD Research Center, will be presenting these novel findings on behalf of the team of investigators.

“If a serum metabolite is heritable and has a shared gene effect with NAFLD, then it could be a useful biomarker of the disease and could potentially be targeted to improve NAFLD in the future,” says Dr. Caussy.

The researchers analyzed a group of 156 people all living in Southern California. The cohort was made up of 37 identical twins, 13 fraternal twins, and 28 sets of sibling/sibling and parent/offspring pairs. Using advanced MRI techniques, the researchers assessed each participant for fat and fibrosis content in the liver. Next, serum metabolites were assessed. And, finally the team looked at the influence of genes and environment to estimate the heritability of the serum metabolites and the shared gene effect between serum metabolites and NAFLD.

Among the group of 156, 36 people with NAFLD were identified. Of 713 serum metabolites analyzed, 440 were found to be heritable. Among them, 56 serum metabolites had a shared gene effect with NAFLD when the researchers adjusted their findings to consider age, sex, and Hispanic ethnicity.

“We found that the novel serum metabolite, phenyllactate (derived from gut‐biome), had a significant shared gene effect with NAFLD,” explains Dr. Caussy of the findings. “This suggests a potential link between genetics and gut‐microbiome in the development of NAFLD and provides evidence that several serum metabolites associated with NAFLD are heritable.”

These findings may be useful biomarkers of disease severity and could also potentially be targeted to improve treatment for NAFLD.

“Our next goal is to validate these findings across the entire spectrum of NAFLD, and assess if phenyllactate decreases with the improvement of NAFLD treatments,” says Dr. Loomba.

Dr. Caussy will present these findings at AASLD’s press conference in Room 103B at the Walter E. Washington Convention Center in Washington, D.C. on Saturday, October 21 at 4 PM. Dr. Caussy will present the study entitled “Heritability and Shared Gene Effects of Novel Gut Microbiome Associated Serum Metabolite in NAFLD: A Twin Study” on Monday, October 23 at 3 PM in Room 202. The corresponding abstract (199) can be found in the journal HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® 2017 - New study shows aspirin reduces liver cancer risk related to hepatitis B

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The Liver Meeting® 2017

New study shows aspirin reduces liver cancer risk related to hepatitis B

WASHINGTON – A new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that daily aspirin therapy was significantly associated with a reduced risk in hepatitis B virus‐related liver cancer.

Hepatitis B is a viral infection that attacks the liver. HBV can be contracted through contact with an infected person’s blood or other bodily fluid, and the infection can either be acute or chronic. According to AASLD’s Guidelines for Treatment of Chronic Hepatitis B, an estimated 240 million people worldwide have chronic HBV, and the highest prevalence of the virus is in Africa and Asia. Death from HBV is commonly due to the development of cirrhosis (scaring of healthy liver tissue) or hepatocellular carcinoma (liver cancer).

Past research suggests that daily aspirin therapy — which is often prescribed to prevent cardiovascular disease — may also prevent the development of cancer. However, clinical evidence is lacking for the effectiveness of aspirin therapy in preventing HBV‐related liver cancer.

Researchers at Taichung Veterans General Hospital in Taichung, Taiwan; E‐Da Hospital in Kaohsiung, Taiwan; Fu Jen Catholic University in New Taipei City, Taiwan; and National Taiwan University Hospital in Taipei conducted a nationwide cohort study to determine if aspirin therapy could, indeed, reduce liver cancer risk.

“Liver cancer is the second leading cause of cancer death worldwide, and HBV is the most prevalent risk factor in our region, says Teng‐Yu Lee, MD, PhD, a researcher in the Department of Gastroenterology at Taichung Veterans General Hospital and lead investigator in the study. “HBV‐related liver cancer is therefore a major public health issue with a severe socioeconomic impact.”

Although current antiviral medicines such as nucleos(t)ide analogue therapy could significantly reduce liver cancer risk, Dr. Lee notes these therapies do not completely eliminate the risk. Additionally, Dr. Lee says most HBV carriers are not indicated for antiviral therapy, so another effective way of reducing liver cancer risk needs to be developed.

“Aspirin has been investigated to explore its chemopreventive effect in cancers that are related to chronic inflammation, particularly in the prevention of colorectal cancer. However, clinical evidence supporting the chemopreventive effect of aspirin therapy on liver cancer remains limited. Therefore, we conducted a large‐scale cohort study to evaluate the association of aspirin therapy with HBV‐related liver cancer.”

The researchers retrieved medical records from the National Health Insurance Research Database between 1998 and 2012 for their study. They screened records of 204,507 patients with chronic hepatitis B, and excluded patients with other forms of infectious hepatitis. After excluding patients with liver cancer before the follow‐up index dates, 1,553 patients who had continuously received daily aspirin for at least 90 days were randomly matched 1:4 with 6,212 patients who had never received anti‐ platelet therapy by means of propensity scores consisting of baseline characteristics, the index date and nucleos(t)ide analogue (NA) use during follow‐up. The researchers analyzed both cumulative incidences of and hazard ratios for HCC development after adjusting for competing mortality.

Cumulative incidence of liver cancer in the group treated with aspirin therapy was significantly lower than that in the untreated group in five years. In their multivariate regression analysis, the researchers found aspirin therapy was independently associated with reduced liver cancer risk. Sensitivity subgroup analyses also verified this association. Older age, male gender, cirrhosis and diabetes also were independently associated with an increased risk, but nucleos(t)ide analogue or statin use was associated with a decreased risk.

“For effectively preventing HBV‐related liver cancer, the findings of this study may help hepatologists treat patients with chronic HBV infection in the future, particularly for those who are not indicated for antiviral therapy. We are pursuing prospective investigations for further confirming the findings,” says Dr. Lee.

Dr. Lee will present “Association of Aspirin Therapy with Reduced Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B” at the Walter E. Washington Convention Center in Washington, D.C., on Monday, October 23 at 4:45 pm in Room 145. The corresponding abstract (223) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® 2017 - Screening for Hepatitis C Improves Opioid Abuse Treatment Outcomes

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The Liver Meeting® 2017


Screening for Hepatitis C Improves Opioid Abuse Treatment Outcomes

Washington, D.C. – Research presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – shows people in treatment for opioid substance abuse significantly lowered their non‐prescribed opioid use after testing positive for hepatitis C virus.

Hepatitis C virus, commonly called HCV, is a liver disease that ultimately can cause cirrhosis (scarring of the liver), liver cancer and liver failure. HCV is mainly contracted when a person comes in contact with an infected person’s blood. One of the most common ways to contract HCV is through needle sharing to inject drugs – thus making HCV an additional concern for those working to combat the opioid epidemic.

There are many complicated facets to the opioid epidemic. In Canada, the province of Ontario has more than 50,000 opioid‐dependent people who are engaged in opioid substitution therapy, using mainly methadone and suboxone.

“Hepatitis C – with an estimated prevalence of 0.3 to 0.9 percent among all Canadians – is more common among people who are opioid dependent (prevalence approaching 65‐67%), and many experts have started advocating for testing all people engaged in opioid substitution therapy for chronic HCV infection,” says Hooman Farhang Zangneh, MD, MSc; post‐doctoral research fellow; Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto and lead investigator in the study. “To date, the impact of HCV infection diagnosis on the substance use behaviors of people engaged in opioid substitution therapy is largely unknown and not completely understood, and our team aimed to see if screening and/or diagnosis could impact their behaviors.”

The researchers conducted a retrospective study looking at electronic health data, urine toxicology and antibody‐based HCV infection screening information from a network of 43 addiction treatment clinics in Ontario from 2000 to 2013. Across the 43 clinics, the researchers identified 2,406 patients who were screened for HCV infection. Of this group, nearly 22 percent tested positive for HCV.

Next, the researchers evaluated substance use for each one of these patients over the course of a year. They found that those who screened positive for HCV were 32.6 percent more likely to significantly alter their substance‐use. They also noted, through urine toxicology, those who tested positive for HCV reduced their consumption of non‐prescribed opioids – when compared to those who tested negative. In fact, this group had significantly lower positive urine drug screens for non‐prescribed opioids, benzodiazepines and cocaine.

“Our study showed awareness of HCV infection among this particular population may motivate them to reduce their consumption and hopefully high‐risk behavior,” explains Dr. Zangneh. “Furthermore, bearing in mind that effective, accessible and durable curative options are currently available, it is highly advisable to screen these clients and use this opportunity as an appropriate time to share motivational and educational resources and information with them. This way, we can provide enhanced support for them, which will have beneficial effects in both individual and societal levels.”

Dr. Zangneh plans to follow this study with a qualitative study to further research the effects of HCV screening in this population and to provide insights into the best ways to link them to proper care.

Dr. Zangneh will present these findings at AASLD’s press conference Saturday, October 21 from 4 ‐ 5:30 PM in Room 103B at the Walter E. Washington Convention Center in Washington, D.C. Dr. Zangneh will present the study entitled “The impact of hepatitis C diagnosis on substance‐use behaviors in patients engaged in opioid substitution therapy” on Sunday, October 22 at 5:45 PM in Room 146. The corresponding abstract (125) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.

The Liver Meeting® 2017 - The Frequency of Herbal and Dietary Supplement Mislabeling

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The Liver Meeting® 2017

The Frequency of Herbal and Dietary Supplement Mislabeling

Washington, D.C. – Herbal and dietary supplement mislabeling is common and should be evaluated as a potential cause for liver damage, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

The herbal and dietary supplements industry is a multi‐billion‐dollar‐per‐year enterprise in the United States. Over 20 percent of cases of liver injury reported to the U.S. Drug Induced Liver Injury Network (called DILIN) are attributed to herbal and dietary supplements.

“Since herbal and dietary supplements are not required by the FDA to be tested for safety or effectiveness, the DILIN has focused on various factors that could explain their potential for harm,” says Victor Navarro, MD, chair of Hepatology for Einstein Medical Center in Philadelphia.

There is a growing concern that potentially mislabeled products may contain ingredients that can be highly toxic, and damaging, to the liver. To assess this, Dr. Navarro’s team of researchers used samples of herbal and dietary supplements collected by DILIN to analyze the contents of these products and determine the frequency of mislabeling.

Between 2003 and March 2016, DILIN collected 341 herbal and dietary supplement products from 1,268 patients enrolled in DILIN. The National Center for Natural Products Research at the University of Mississippi conducted a chemical analysis on 229 of these products. The ingredients, as they were determined by the chemical analysis, where then compared to the ingredients listed on the 203 analyzed products that contained a label.

As determined through the chemical analysis, Dr. Navarro’s team found only 90 of 203 products contained labels that accurately reflected their contents. Mislabeling – defined by the researchers as when the chemical analysis did not confirm the ingredients listed on the label – occurred in 80 percent of products used for body building and performance enhancement, and 72 percent of products used for weight loss. “Based on these findings, the DILIN will embark upon a more detailed analysis of the chemical ingredients, to determine the precise cause of the liver injury”.

Dr. Navarro will present these findings at AASLD’s press conference in Room 103B at the Walter E. Washington Convention Center in Washington, D.C on Saturday, October 21 at 4 PM. Dr. Navarro will present the study entitled “The Frequency of Herbal and Dietary Supplement Mislabeling: Experience of the Drug Induced Liver Injury Network” on Tuesday, October 24 at 10:15 AM in the Ballroom. The corresponding abstract (264) can be found in the journal, HEPATOLOGY (link is external).

About AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.

AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.

Press releases and additional information about AASLD are available online at www.aasld.org.