Showing posts with label cirrhosis. Show all posts
Showing posts with label cirrhosis. Show all posts

Sunday, August 5, 2018

Hepatitis C-Diabetes associated w-advanced fibrosis and progression in HCV non-genotype 3 patients

In case you missed it

Dig Liver Dis. 2018 Jul 17. pii: S1590-8658(18)30814-4. doi: 10.1016/j.dld.2018.07.003. 
[Epub ahead of print]

Diabetes is associated with advanced fibrosis and fibrosis progression in non-genotype 3 chronic hepatitis C patients.

Researchers investigated if diabetes is associated with progression from the non-cirrhotic liver to cirrhosis in non-genotype 3 chronic hepatitis C (CHC) patients. In the study 976 non-genotype 3 patients with HCV were studied, out of the 976 participants, 684 did not have cirrhosis. According to ultrasound findings, 60 patients developed cirrhosis during the follow-up period. In non-genotype 3 CHC patients, diabetes was correlated with progression from the non-cirrhotic liver to cirrhosis.

Abstract
BACKGROUND:
Diabetes is a risk factor of fibrosis progression in chronic hepatitis C (CHC). However, only one longitudinal study exploring whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in CHC patients has been conducted.

AIMS: 
We investigated whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients.

METHODS: 
A cohort consisting of 976 non-genotype 3 patients histologically proven to have CHC was studied. After excluding patients with biopsy-proven or ultrasound-identified cirrhosis, there were 684 patients without cirrhosis. All 684 patients underwent hepatocellular carcinoma surveillance using ultrasound every 6 months, with a median duration of follow-up evaluation of 102.4 months. During the follow-up period, 60 patients developed cirrhosis according to ultrasound findings.

RESULTS: 
For the subgroup of 684 patients without cirrhosis, Kaplan-Meier survival analyses showed no significantly different cumulative incidences of cirrhosis (log-rank test; P = 0.71) among the patients with diabetes as compared to those without. However, after making adjustments for age, gender, fibrosis, steatosis, sustained virological response status, and obesity using Cox's proportional hazard model, diabetes was found to be an independent predictor for cirrhosis (HR = 1.9; 95% CI = 1.05-3.43, P = 0.03).

CONCLUSIONS: 
Diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients.

KEYWORDS:
Diabetes; Genotype 3; Hepatitis C virus; Liver cirrhosis; Ultrasound
PMID: 30076015 DOI: 10.1016/j.dld.2018.07.003 
Full text article requires payment 

Friday, August 3, 2018

New online calculator predicts clinical improvement in liver failure after Hep C treatment

New online calculator predicts clinical improvement in liver failure after Hep C treatment
Naveed Saleh, MD, MS, for MDLinx | August 03, 2018
Investigators formulated a five-factor metric known as the BE3A score that offers specialists a shared decision-making tool to predict potential improvements after treatment in patients with hepatitis C virus (HCV)-associated liver failure, as detailed in a new study published in Gastroenterology
Continue reading @ MDLinx.

To use the calculator online, go to www.be3ascore.com.

Study - Gastroenterology
June 2018 Volume 154, Issue 8, Pages 2111–2121.e8

Long–term effect of liver fibrosis after SVR in patients with HCV

Journal of Viral Hepatitis, July 27, 2018 

Cirrhosis, High Age and High Body Mass Index Are Risk Factors for Persisting Advanced Fibrosis After Sustained Virological Response in Chronic Hepatitis C
M. Hedenstierna; A. Nangarhari; A. El-Sabini; O. Weiland; S. Aleman
J Viral Hepat. 2018;25(7):802-810.

The aim of this study was to investigate the long–term effect of achieved SVR on liver fibrosis, measured as liver stiffness with transient elastography, in a cohort with pretreatment advanced chronic HCV infection. We also aimed to identify risk factors associated with persisting fibrosis.

Abbreviations
BMI, body mass index; CI, confidence interval; DM, diabetes mellitus; FU, follow-up; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; LSM, liver stiffness measurement; OR, odds ratio; SVR, sustained virological response.

Discussion Only
View Complete article: https://www.medscape.com/viewarticle/898758_1
The long–term effect of achieved SVR on liver fibrosis in patients with HCV–induced advanced fibrosis has not been extensively investigated. To study this, fibrosis in our patients was assessed by LSM during long–term follow–up over more than 5–10 years. Our study shows that the vast majority of our 269 patients with pretreatment advanced fibrosis or cirrhosis improved their fibrosis during long–term follow–up after SVR. A minority, however, continued to have advanced fibrosis even after more than 5–10 years of follow–up. In this subset of patients, a point of no return for advanced liver fibrosis might have been reached, where improvement is not possible. Other possible explanations are contributing cofactors such as liver steatosis with inflammation and alcohol use as driving forces to maintain or even progress liver fibrosis. In this study, we identified pretreatment cirrhosis, high age and high BMI as the main risk factors for lack of improvement. The proportion of patients who maintained advanced fibrosis decreased among patients with longer follow–up time, indicating that fibrosis regression is a slow process that continues over time.

Several studies with varying follow–up times have compared pre– and post–treatment fibrosis stages.[10,19–27] Studies based on liver biopsies have all shown that fibrosis and also cirrhosis can improve after achievement of SVR in a majority of patients, but also that fibrosis will persist or progress after SVR in a subset of 1%–14%, confirming the results in our study.[19–23] In a large study including more than 3000 biopsied patients with a mean follow–up time of 20 months, a low baseline fibrosis stage, age below 40 and BMI below 27 were all factors strongly associated with lack of significant fibrosis at follow–up in patients with SVR.[19] The risk factors identified to be associated with persisting fibrosis found were the same as in our long–term study.

More recent studies have investigated fibrosis regression after SVR with LSM and biochemical markers. The diagnostic accuracy of these methods to detect persisting cirrhosis after SVR, however, has been questioned.[10,24] In a study comparing LSM with follow–up biopsies 61 months after achieved SVR, the sensitivity of LSM to detect cirrhosis after SVR was only 61% when standard pretreatment cut–offs were used.[10] On the other hand, the specificity for diagnosing cirrhosis with LSM after treatment reached 95%. As LSM measures both fibrosis and inflammation, rapid early improvement of liver stiffness after SVR could be explained by a reduction in liver inflammation, and not by fibrosis regression. This could suggest that patients with pretreatment cirrhosis defined by LSM, including some with severe inflammation and less advanced fibrosis, would have lower liver stiffness at follow–up than patients with biopsy–proven cirrhosis. Surprisingly, in our study, we observed the opposite. The difference was not significant, but could be explained by the fact that patients with cirrhosis defined by LSM had shorter follow–up times. This supports our conclusion that cirrhosis regression is a process that continues over time. Recently published studies with repeated LSM up to 2 years after achieved SVR have shown a rapid initial improvement of liver stiffness, but also a continued slower reduction, better reflecting true fibrosis regression.[25–27] The follow–up times in these studies were relatively short, but the findings support the results generated in our study. Another possible explanation for the initial rapid and later slower improvement of liver stiffness levels after SVR could be the remaining presence of nodular architecture in the liver, despite decreased amount of fibrosis.[21] Nodules are the hallmark for a histopathological definition of cirrhosis.[5] This implies that the persisting advanced fibrosis in our study, measured by LSM, probably is accurate, while we might have misclassified the stage of fibrosis in some of the cirrhotic patients that still had nodular architecture.

Although this study was not designed to assess the correlation between LSM and the risk to develop HCC, there were patients in our study with improved fibrosis who later developed HCC up to 15 years after SVR. This finding supports that surveillance for HCC should continue even in patients where cirrhosis has regressed after achieved SVR. The duration for such surveillance needs to be further studied. We have earlier found that diabetes and the presence of pretreatment cirrhosis were risk factors for the development of HCC after SVR had been achieved.[13] No direct correlation between diabetes mellitus and persisting advanced fibrosis was noted in this study. On the other hand, high BMI, known to be associated with diabetes, was found to be a risk factor for persisting advanced fibrosis.

There are several limitations to this study. It had a cross–sectional and retrospective design and lacked sequential LSMs for the included patients. However, in a preliminary prospective study on LSM data collected at 6–month intervals after SVR in 100 patients with F3–F4 fibrosis at baseline, 31% had persisting advanced fibrosis, similar to the results in our study.[28] Furthermore, in our study, a third of the eligible patients were excluded or lost to follow–up, which could introduce a selection bias. Baseline characteristics for the nonincluded patients were, however, comparable to the studied patients, reducing this bias. The clinical outcome was worse in the excluded group with higher occurrence of HCC and death, but the causes of death were not liver related in a majority of the cases.

Assessment of fibrosis after SVR with transient elastography and not liver histology may have caused us to underestimate the extent of advanced fibrosis at follow–up. However, the identified patients with maintained advanced fibrosis are probably correctly classified. As all our patients were treated with IFN–based regimens, we do not know if our findings are relevant for patients treated with IFN–free regimens. One recently published study, however, showed a statistically similar median change in LSM levels 24 weeks after the end of treatment in patients with SVR after IFN–containing and IFN–free regimens.[25]

To conclude, we found that the liver fibrosis after achievement of SVR improved in the vast majority of our patients after long–term follow–up. Our data indicate that fibrosis regression is an ongoing long–term process over years. Risk factors for lack of such improvement during follow–up were pretreatment cirrhosis, older age and high body mass index. Lifestyle intervention to decrease weight in obese persons and treatment before establishment of cirrhosis at a younger age should therefore be recommended to avoid persistence of advanced fibrosis after SVR.

Free registration may be required to view article.
Abstract and Introduction
Patients and Methods
Results
Discussion

Friday, July 27, 2018

Pain management in patients with cirrhosis

Clinical Liver Disease
Volume 11, Issue 6
Pages: 135-161
Clinical Liver Disease (CLD) is an online learning resource of American Association for the Study of Liver Diseases. CLD blends text, audio, video, webinars, and other interactive content into educational interventions launched every other month.

The latest publication of Clinical Liver Disease is all about cirrhosis, with a summary featuring: Pain management in patients with cirrhosis

Many of the commonly used over-the-counter analgesics such as acetaminophen and prescription pain relievers are metabolized through the liver, posing unique pain management challenges for patients and clinicians. This review will highlight the latter, and discuss the use of opioids, antidepressants, and marijuana, as well.
Patients with cirrhosis often experience pain. Yet pain remains one of the most undertreated symptoms in this patient population. A variety of medications are available to help address pain; however, several factors have to be taken into consideration prior to starting any pain regimen in patients with cirrhosis. Factors to consider include potential for overuse/abuse, severity of hepatic and renal impairment, and presence of hepatic encephalopathy. Chronic pain can be well managed in patients with cirrhosis; however, choice of analgesic and dosing regimen should be highly individualized and side effects carefully monitored.
Mina Rakoski, Preeya Goyal, Michelle Spencer-Safier, Jill Weissman, Gina Mohr and Michael Volk
Version of Record online: 26 JUL 2018 | DOI: 10.1002/cld.711
Watch a video presentation of this article
Abstract
Full text

Table of Contents
Reviews


AASLD Debate 2017

Radiology in Liver Disease
Begin here.... 

Updates Elsewhere
Hepatology News Tonight: Managing Complication of Cirrhosis
Naoky Tsai, MD; Ashwani K. Singal, MD
View: Managing Complication Of Cirrhosis, launched April 2018, provided by Chronic Liver Disease Foundation CLDF.


Wednesday, July 11, 2018

All-oral direct antiviral treatment for hepatitis C in a real-life cohort: The role of cirrhosis and comorbidities in treatment response

All-oral direct antiviral treatment for hepatitis C chronic infection in a real-life cohort: The role of cirrhosis and comorbidities in treatment response 
Noelle Miotto , Leandro Cesar Mendes, Leticia Pisoni Zanaga,Maria Silvia Kroll Lazarini, Eduardo Sellan Lopes Goncales, Marcelo Nardi Pedro, Fernando Lopes Goncales Jr, Raquel Silveira Bello Stucchi, Aline Gonzalez Vigani

Full Article

Abstract
Background
Hepatitis C virus (HCV) infection is the major cause of end-stage liver disease (LD) worldwide. The aim of this study was to assess sustained virological response (SVR) rates in a real-world cohort of patients with HCV infection treated with interferon-free direct antiviral agents (DAA).

Patients and methods
All patients with genotypes 1, 2 or 3 HCV infection who started interferon-free treatment at a university hospital from December 2015 through July 2017 were included. The primary outcome was SVR at post-treatment week 12 by intention-to-treat (ITT) and modified ITT (mITT) analysis.

Results
Five hundred twenty seven patients were enrolled, 51.6% with cirrhosis. Most patients received sofosbuvir + daclatasvir + ribavirin (60.7%) and sofosbuvir + simeprevir (25.6%). Overall SVR rates were 90.5% for ITT and 96% for mITT. SVR rates were higher in non-cirrhotic (94.2% in ITT and 96.8% in mITT) versus cirrhotic patients (87.1% in ITT and 95.2% in mITT). In ITT and mITT assessments, SVR rates were higher in patients with Child-Pugh A (n = 222, 88.7% and 95.7%, respectively) versus Child-Pugh B or C (n = 40, 80% and 90%, respectively); SVR rates were higher in patients with genotype 1 (n = 405, 92.1% and 98.2%), followed by genotype 2 (n = 13, 84.6% and 92.7%) and genotype 3 (n = 109, 84.4% and 88.4%). Lower comorbidity index (p = 0.0014) and absence of cirrhosis (p = 0.0071) were associated with SVR. Among cirrhotic patients, lower Model for End-Stage Liver Disease (p = 0.0258), higher albumin (p = 0.0015), and higher glomerular filtration rate (p = 0.0366) were related to SVR. Twenty-two cirrhotic patients (8%) had clinical liver decompensation during treatment. Complications of advanced LD were responsible for discontinuation of treatment and death in 12 and 7 patients, respectively.

Conclusion
Treatment with all-oral DAA achieved high SVR rates, particularly in patients without cirrhosis and few comorbidities. Advanced LD is associated to poor outcome, such as treatment failure and death.

Thursday, June 21, 2018

60,000 adults in the UK have cirrhosis, nearly 75% percent don't know it


7 in 10 people with liver disease in the UK don’t even know they have it 
Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

The British Liver Trust’s Love Your Liver campaign focuses on three simple steps to Love Your Liver back to health:

- Drink within recommended limits and have three consecutive alcohol-free days every week
- Cut down on sugar, carbohydrates and fat and take more exercise
- Know the risk factors for viral hepatitis and get tested or vaccinated if at risk

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Wednesday, June 13, 2018

High SVR12 with 8-week and 12-week glecaprevir/pibrentasvir therapy: An integrated analysis of HCV genotype 1–6 patients without cirrhosis

High SVR12 with 8-week and 12-week glecaprevir/pibrentasvir therapy: An integrated analysis of HCV genotype 1–6 patients without cirrhosis


Open Access

Highlights
•A short-duration, pangenotypic cure for HCV infection may help treat more patients.
•Glecaprevir plus pibrentasvir (G/P) therapy for 8 weeks had an overall cure rate of 98%.
•The efficacy of 12-week G/P therapy (99%) was not significantly higher than that of 8-week G/P therapy (p = 0.2).
•Treatment responses were high irrespective of any baseline patient or viral trait.
•G/P demonstrated a favourable safety profile regardless of treatment duration.

Background & Aims
Glecaprevir plus pibrentasvir (G/P) is a pangenotypic, once-daily, ribavirin-free direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection. In nine phase II or III clinical trials, G/P therapy achieved rates of sustained virologic response 12 weeks after treatment (SVR12) of 93–100% across all six major HCV genotypes (GTs). An integrated efficacy analysis of 8- and 12-week G/P therapy in patients without cirrhosis with HCV GT 1–6 infection was performed.

Methods
Data were pooled from nine phase II and III trials including patients with chronic HCV GT 1–6 infection without cirrhosis who received G/P (300 mg/120 mg) for either 8 or 12 weeks. Patients were treatment naïve or treatment experienced with peginterferon, ribavirin, and/or sofosbuvir; all patients infected with HCV GT 3 were treatment naïve. Efficacy was evaluated as the SVR12 rate.

Results
The analysis included 2,041 patients without cirrhosis. In the intent-to-treat population, 943/965 patients (98%) achieved SVR12 when treated for eight weeks, and 1,060/1,076 patients (99%) achieved SVR12 when treated for 12 weeks; the difference in rates was not significant (p = 0.2). A subgroup analysis demonstrated SVR12 rates > 95% across baseline factors traditionally associated with lower efficacy. G/P was well tolerated, with one DAA-related serious adverse event (<0.1%); grade 3 laboratory abnormalities were rare.

Conclusions
G/P therapy for eight weeks in patients with chronic HCV GT 1–6 infection without cirrhosis achieved an overall SVR12 rate of 98% irrespective of baseline patient or viral characteristics; four additional weeks of treatment did not significantly increase the SVR12 rate, demonstrating that the optimal treatment duration in this population is eight weeks.

Lay summary
In this integrated analysis of nine clinical trials, patients with chronic HCV genotype 1–6 infection without cirrhosis were treated for either 8 or 12 weeks with the direct-acting antiviral regimen glecaprevir/pibrentasvir (G/P). The cure rate was 98% and 99% following 8 and 12 weeks of treatment, respectively; the difference in rates was not significant (p = 0.2), nor was there a significant difference in the cure rates across the two treatment durations on the basis of baseline patient or viral characteristics. These results, along with a favourable safety profile, indicate that G/P is a highly efficacious and well-tolerated pangenotypic eight-week therapy for most patients with chronic HCV infection.

Friday, June 8, 2018

HCV/HIV-coinfection - Successful direct acting antiviral (DAA) treatment before and after liver transplantation

PLOS ONESuccessful direct acting antiviral (DAA) treatment of HCV/HIV-coinfected patients before and after liver transplantation
Julia M. Grottenthaler, Christoph R. Werner, Martina Steurer, Ulrich Spengler, Thomas Berg, Cornelius Engelmann, Heiner Wedemeyer, Thomas von Hahn, Wolfgang Stremmel, Anita Pathil, Ulrich Seybold, Eckart Schott, Usha Blessin, Christoph P. Berg

Published: June 6, 2018 https://doi.org/10.1371/journal.pone.0197544 

Links

Abstract
Objectives
The aim of this multicenter retrospective study was to investigate safety and efficacy of direct acting antiviral (DAA) treatment in the rare subgroup of patients with HCV/HIV-coinfection and advanced liver cirrhosis on the liver transplant waiting list or after liver transplantation, respectively.

Methods
When contacting 54 German liver centers (including all 23 German liver transplant centers), 12 HCV/HIV-coinfected patients on antiretroviral combination therapy were reported having received additional DAA therapy while being on the waiting list for liver transplantation (patient characteristics: Child-Pugh A (n = 6), B (n = 5), C (n = 1); MELD range 7–21; HCC (n = 2); HCV genotype 1a (n = 8), 1b (n = 2), 4 (n = 2)). Furthermore, 2 HCV/HIV-coinfected patients were denoted having received DAA therapy after liver transplantation (characteristics: HCV genotype 1a (n = 1), 4 (n = 1)).

Results
Applied DAA regimens were SOF/DAC (n = 7), SOF/LDV/RBV (n = 3), SOF/RBV (n = 3), PTV/r/OBV/DSV (n = 1), or PTV/r/OBV/DSV/RBV (n = 1), respectively. All patients achieved SVR 12, in the end. In one patient, HCV relapse occurred after 24 weeks of SOF/DAC therapy; subsequent treatment with 12 weeks PTV/r/OBV/DSV achieved SVR 12. One patient underwent liver transplantation while on DAA treatment. Analysis of liver function revealed either stable parameters or even significant improvement during DAA therapy and in follow-up. MELD scores were found to improve in 9/13 therapies in patients on the waiting list for liver transplantation; in only 2 patients a moderate increase of MELD scores persisted at the end of follow-up.

Conclusion
DAA treatment was safe and highly effective in this nation-wide cohort of patients with HCV/HIV-coinfection awaiting liver transplantation or being transplanted.

Wednesday, May 16, 2018

Do fatigue and quality of life improve after hepatitis C is cured?

Do fatigue and quality of life improve after hepatitis C is cured?
Keith Alcorn
Published: 16 May 2018

Patient-reported outcomes such as fatigue, vitality and mental health improve substantially in the two years following hepatitis C cure for people with cirrhosis, but people with cirrhosis are less likely than others to experience rapid resolution of severe fatigue after successful hepatitis C treatment, according to two studies from the Center for Outcomes Research in Liver Diseases reported last month at the 2018 International Liver Congress in Paris.

Quality of life can be severely impaired in people with chronic hepatitis C, especially in people with cirrhosis. Fatigue, insomnia, problems in physical functioning, depression, anxiety and mood disorders are reported by a substantial proportion of people with hepatitis C....


Recommended Reading
Conference highlights

Infohep
For more information on hepatitis visit infohep.org.
Infohep is a project we're working on with the World Hepatitis Alliance and the European Liver Patients Association.

Saturday, May 12, 2018

HCV therapy and risk of liver cancer recurrence: who to treat?

Article shared and download by Henry E. Chang on Twitter

Nature reviews gastroenterology & hepatology
HCV therapy and risk of liver cancer recurrence: who to treat?
Massimo Colombo and Vincenzo Boccaccio
The advent of potent and user-friendly direct- acting antiviral agents (DAAs) to treat HCV infection has inflated the expectations that the control of such a potentially lethal disease is now possible. The scrutiny of the huge database of the Veterans Affairs practice has provided unequivocal proof that eradication of HCV with DAAs is attainable in almost all patients with any stage of infection, even in the presence of multiple comorbidities (such as obesity, alcohol abuse and diabetes), resulting in a substantial decline of short- term mortality and de novo hepatocellular carcinoma (HCC) development 1 , 2 . Yet, an area of uncertainty remains regarding the safety and efficacy of these innovative therapies in patients with liver cancer who have already received anticancer therapy.

View the article: https://jumpshare.com/v/PAnSunSpBpEcc4ByR5EK

Recommended Reading
May 4, 2018
High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma
This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.

Tuesday, May 8, 2018

Higher risk of hepatocellular carcinoma in Hispanic patients with hepatitis C cirrhosis and metabolic risk factors

Published:08 May 2018
nature.com - scientific reports

Higher risk of hepatocellular carcinoma in Hispanic patients with hepatitis C cirrhosis and metabolic risk factors
Alina Wong, An Le, Mei-Hsuan Lee, Yu-Ju Lin, Pauline Nguyen, Sam Trinh, Hansen Dang & Mindie H. Nguyen

Full-Text

In summary, this study shows that patients with CHC cirrhosis and super-imposed metabolic syndrome have increased risk of liver-related complications including both hepatic decompensation and HCC. Hispanic patients with two or more metabolic risks are at especially increased risk of developing liver-related complications. As the prevalence of obesity and metabolic syndrome increase across the world, targeted health interventions will be needed to help curb the effects of metabolic syndrome in chronic hepatitis C patients.

Abstract
The effect of metabolic syndrome on chronic liver diseases other than non-alcoholic fatty liver disease has not been fully elucidated. Our goal was to evaluate if metabolic syndrome increased the risk of liver-related complications, specifically hepatocellular carcinoma (HCC) and decompensation, in cirrhotic chronic hepatitis C (CHC) patients. We conducted a retrospective cohort study of 3503 consecutive cirrhotic CHC patients seen at Stanford University from 1997–2015. HCC developed in 238 patients (8-year incidence 21%) and hepatic decompensation in 448 patients (8-year incidence 61%). The incidence of HCC and decompensation increased with Hispanic ethnicity, diabetes, and number of metabolic risk factors. Multivariate Cox regression analysis demonstrated that, independent of HCV therapy and cure and other background risks, Hispanic ethnicity with ≥2 metabolic risk factors significantly increased the risk of HCC and hepatic decompensation. There was no interaction between Hispanic ethnicity and metabolic risk factors. All in all, metabolic risk factors significantly increase the risk of liver-related complications in cirrhotic CHC patients, especially HCC among Hispanics. As the prevalence of metabolic syndrome increases globally, targeted health interventions are needed to help curb the effects of metabolic syndrome in CHC patients.


Friday, May 4, 2018

High efficacy of direct-acting anti-viral agents in hepatitis C infected cirrhotic patients with successfully treated hepatocellular carcinoma

In Case You Missed It

Aliment Pharmacol Ther. 2018 May 3. doi: 10.1111/apt.14685. [Epub ahead of print]

High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma.
Persico M1, Aglitti A1, Aghemo A2, Rendina M3, Lleo A2, Ciancio A4, Di Marco V5, Lampertico P6, Brunetto MR7, Zuin M6, Andreone P8, Villa E9, Troshina G4, Calvaruso V5, Degasperi E6, Coco B7, Giorgini A6, Conti F8, Di Leo A3, Marzi L9, Boccaccio V2, Bollani S2, Maisonneuve P6, Bruno S2.

Full-Text

Abstract
BACKGROUND:
The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown.

AIM:
We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients.

METHODS:
From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen.

RESULTS:
The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class.

CONCLUSION:
This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.
Continue to full article: https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.14685

On This Blog
This page offers an index of links to current data investigating the possible risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after direct-acting antiviral therapy in patients with hepatitis C.

Friday, April 27, 2018

Harvoni effective for HCV genotype 4, including cirrhotic cases

In The Journal
Original article Ledipasvir/sofosbuvir with or without ribavirin for 8 or 12 weeks for the treatment of HCV genotype 4 infection: results from a randomised phase III study in Egypt
gamal Shiha,1,2 gamal esmat,3 Mohamed Hassany,4 reham Soliman,2,5 Mohamed elbasiony,1,2 rabab Fouad,3 aisha elsharkawy,3 radi Hammad,4 Wael abdel-razek,6 talaat Zakareya,6 Kathryn Kersey,7 Benedetta Massetto,7 anu Osinusi,7 Sophia lu,7 Diana M Brainard,7 John g McHutchison,7 imam Waked,6 Wahid Doss4

Full Text
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Significance of this study
What is already known about this subject?
► In Egypt, which has one of the highest prevalences of hepatitis C virus (HCV) infection in the world (6.3%), >90% of patients are infected with HCV genotype 4.
► At the time of study design, sofosbuvir was the only direct-acting antiviral (DAA) drug available in Egypt. As such, the only DAA treatment options were sofosbuvir plus ribavirin plus pegylated interferon for 12 weeks, or sofosbuvir plus ribavirin for 24 weeks; there were no treatment options for patients who had failed direct-acting antiviral agent therapy.
► We sought to find the optimal regimen for ledipasvir–sofosbuvir in Egypt. Shorter treatment durations and/or the removal of ribavirin and pegylated interferon and their associated toxicities would be of benefit to patients. What are the new findings?
► Treatment-naive patients without cirrhosis were effectively and safely treated with the fixeddose combination of ledipasvir/sofosbuvir for 8 weeks.
► Rates of sustained virological response 12 weeks post-treatment (SVR12) of ≥94% were observed with 12 weeks of ledipasvir/ sofosbuvir±ribavirin treatment in interferonexperienced patients with or without cirrhosis. All sofosbuvir or ledipasvir–sofosbuvirexperienced patients in this study achieved SVR12 with 12 weeks of ledipasvir–sofosbuvir plus ribavirin for 12 weeks.
► Overall, the addition of ribavirin did not appear to increase rates of SVR observed with ledipasvir–sofosbuvir, but it was associated with an increase in the incidence of adverse  events.
Continue to article: http://gut.bmj.com/content/gutjnl/early/2018/04/21/gutjnl-2017-315906.full.pdf

Commentary @ Healio
Harvoni effective for HCV genotype 4, including cirrhotic cases
April 27, 2018 
Patients with hepatitis C genotype 4 had high sustained virologic response rates with Harvoni over 8 weeks in treatment-naive cases without cirrhosis and over 12 weeks with ribavirin regardless of cirrhosis or treatment experience, according to recently published data from a phase 3 study in Egypt.

“Given the high prevalence of HCV in Egypt and the heterogeneity of the HCV-infected population with respect to age, comorbidities and prior HCV therapy, there is a need in Egypt for a highly efficacious, well-tolerated, single-tablet regimen with simple monitoring,” Gamal Shiha, MD, PhD, from the Liver Research Institute and Hospital in Egypt, and colleagues wrote. “With the widespread use of sofosbuvir, an efficacious treatment for those who have failed treatment with a sofosbuvir-based regimen would also be highly desirable.”

Full Article: https://www.healio.com/hepatology/hepatitis-c/news/online/%7B30747e3b-aaf2-4095-ab47-fb6278189b95%7D/harvoni-effective-for-hcv-genotype-4-including-cirrhotic-cases

Saturday, April 21, 2018

Albumin predicts cirrhosis improvement after SVR with DAAs

Albumin predicts cirrhosis improvement after SVR with DAAs
April 20, 2018

PARIS — Rapid improvement in albumin levels after 4 weeks of treatment with direct-acting antivirals for hepatitis C significantly predicted long-term clinical and biochemical improvements among patients with advanced liver disease, according to a presentation at the International Liver Congress 2018.

“The introduction of DAAs has completely changed the HCV setting in clinical practice,” Chiara Mazzarelli, MD, from King’s College Hospital, United Kingdom, said in her presentation. “As hepatologists, we know that HCV clearance ... is associated with improvement and normalization of liver function.”

On This Blog

Friday, April 20, 2018

International Liver Congress 2018 - Webinars covering critical studies on viral hepatitis and NAFLD/NASH

Clinical Care Options 
Program Overview
2018 Annual Meeting of the European Association for the Study of the Liver*
April 11-15, 2018 | Paris, France

Review Capsules Summaries, download slides, and listen to audio commentary from expert-led Webinars covering critical studies on viral hepatitis and NAFLD/NASH from Paris.
Link: https://www.clinicaloptions.com/Hepatitis/Conference%20Coverage/Paris%202018.aspx

Free registration required

Viral Hepatitis
Listen to downloadable audio from a live Webinar in which Stefan Zeuzem, MD, assessed the clinical impact of new data reported at the Paris meeting and answered case questions from participants.

Addition of RBV Associated With Increased Efficacy of 12 Weeks Sofosbuvir/Velpatasvir in Patients With Genotype 3 HCV Infection and Compensated Cirrhosis

Retreatment of Patients Who Failed Glecaprevir/Pibrentasvir Treatment for Hepatitis C Virus Infection

A Phase 3b, Open-Label, Randomized, Pragmatic Study of Glecaprevir/Pibrentasvir +/- Ribavirin (RBV) for HCV Genotype 1 Subjects Who Previously Failed an NS5A Inhibitor + Sofosbuvir (SOF) Therapy

8 Weeks Sofosbuvir/Velpatasvir in Genotype 3 Patients With Significant Fibrosis: Highly Effective Amongst an OST Cohort

Safety and Efficacy at 1 Year After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Chronic HBV Patients With Risk Factors for TDF Use

High Efficacy and Safety of Grazoprevir and Elbasvir for 8 Weeks in Treatment-Naive, Nonsevere Fibrosis HCV GT1B-Infected Patients: Interim Results of the STREAGER Study


NAFLD/NASH
Capsule Summaries (4) 
Low-Moderate Alcohol Use Is Associated With a Lower Prevalence of Nonalcoholic Fatty Liver Disease in Hispanics/Latinos Living in the US: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Substantial Comorbidities and Rising Economic Burden In Real-World Nonalcoholic Fatty Liver Disease (NAFLD)/Nonalcoholic Steatohepatitis (NASH) Patients With Compensated Cirrhosis (CC): A Large German Claims Database Study

Nonalcoholic Fatty Liver Disease and Relative Risk of Incident Steatohepatitis, Cirrhosis and Hepatocellular Carcinoma Events in 4 European Primary Care Databases

Prevalence and Stratification of NAFLD/NASH in a UK and US Cohort Using Noninvasive Multiparametric MRI

Begin here.......

Monday, April 16, 2018

DAA therapy effective in patients with HCV and advanced cirrhosis - Real World Experience from the HCV-TARGET Cohort

The International Liver Congress 2018


Healio Coverage
DAA therapy effective in patients with HCV and advanced cirrhosis
April 16, 2018
PARIS — Direct-acting antiviral therapy effectively treated hepatitis C virus in patients with high MELD scores, producing a high rate of sustained viroloic response, according to a presentation at the International Liver Congress 2018.

“Real-life SVR rates with DAAs in patients with advanced liver disease ranged from 85% to 100% and were comparable to clinical trial experience. Ribavirin did not influence SVR in this cohort,” Elizabeth C. Verna, MD, of Columbia University, said in her presentation. “Over the year following treatment, stabilization or marginal improvement is seen in those with low MELDs while greater degree of improvement may occur in patients with MELD greater than 16.”

Verna and colleagues used the HCV-TARGET database of patients to cull patients with cirrhosis and MELD higher than 10. Patients initiated DAA therapy between March 2014 and June 2017. Patients with prior liver transplant were excluded. The researchers enrolled 488 patients in the safety cohort and 412 patients in the efficacy cohort; of those, 373 achieved SVR12 and 39 failed treatment. Patients received a variety of approved regimens.



On This Blog

Friday, April 13, 2018

Germany: compensated cirrhosis substantially increases comorbidities and healthcare costs for patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis

Germany: compensated cirrhosis substantially increases comorbidities and healthcare costs for patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis

European Association for the Study of the Liver

13 April 2018, Paris, France: An analysis of outcomes and costs for German patients with non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) who develop compensated cirrhosis was presented today at The International Liver Congress™ 2018 in Paris, France. Healthcare costs for this population spiked in the first year after compensated cirrhosis diagnosis. Comorbidities were common and one in five patients died within a year of cirrhosis diagnosis, highlighting the need for new treatment options to improve outcomes in these patients.

NAFLD is a major cause of liver disease worldwide with a global prevalence of 25% that is, alarmingly, thought to be rising, fueled by the global epidemic of obesity.9 The progression from NAFLD to NASH to advanced fibrosis is well established.9 For patients with NAFLD/NASH, increased morbidity and mortality is associated with increasing fibrosis. 10

'We know that compensated cirrhosis is often caused by NASH, but data on the associated morbidity, mortality, healthcare utilization and costs within the population of Germany are lacking', explained Dr Ali Canbay from the University of Magdeburg Medical School in Germany, and lead author of the study. 'We were able to extract these data from a large, anonymized billing database'.

The study presented by Dr Canbay obtained retrospective claims data for adult patients with a NAFLD/NASH diagnosis between 2011 and 2016 using the InGef FDB database (which contains anonymized billing data for about 6.3 million persons in about 60 health insurances in Germany).11,12 A total of 800 patients who had a subsequent diagnosis of compensated cirrhosis were included in the analysis. Of these, 245 (30.6%) individuals progressed to end-stage liver diseases (ESLDs) (progressors) and 555 (69.4%) remained cirrhotic (non-progressors) within 1 year of follow-up after their cirrhosis index diagnosis. Comorbidities, all-cause mortality within 1 year of the cirrhosis index diagnosis, annual healthcare utilization, annual mean costs (1 year pre-index to 1 year post-index period) and cumulative mean costs (1 year to maximum 5 years pre-index and post-index period) were presented.

In the 1-year pre-index period, the most prevalent comorbidities were hypertension (78.8 %), type-2 diabetes mellitus (52.6%), cardiovascular diseases (48.8%) and hyperlipidaemia (47.5%). In the first year of the post-index period, 19.4% of the patients died. This percentage was significantly higher for progressors (46.1%) than non-progressors (7.6%) (p<0.05). Following the cirrhosis diagnosis, the mean annual number of all-cause hospitalizations and emergency room visits increased significantly by 91% and 106.8%, respectively (p<0.05).

During the 1-year pre-index period, the mean of annual all-cause healthcare cost was €6,146 per patient. In the first post-index year there was a substantial and significant increase (93%, p<0.05) in annual all-cause healthcare cost per patient to a mean of €11,877. The primary driver of healthcare costs was the inpatient setting, which accounted for 42.0% of pre-index costs and 68.4% of post-index costs. Cumulative mean costs for cirrhosis patients increased 143% over the 5-year period of the study (p<0.05).

'We demonstrated that German patients with NAFLD/NASH who develop compensated cirrhosis have a substantial burden of comorbidities and that their healthcare costs jump with the development of cirrhosis', said Dr Canbay. 'Novel treatment options are needed to improve patient outcomes'. 'This study highlights the burden of NASH cirrhosis on healthcare systems and reinforces the need for new therapies to tackle the epidemic currently affecting many European countries', said Prof. Phil Newsome from the Queen Elizabeth Hospital and University of Birmingham, UK, and EASL Governing Board Member.

References
9. Younossi ZM, et al. Global epidemiology of nonalcoholic fatty liver disease - meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
10. Hagström H, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265-73.
11. Andersohn F, Walker J. Characteristics and external validity of the German Health Risk Institute (HRI) Database Pharmacoepidemiol Drug Saf. 2016;25(1):106-9.
12. The Institute for Applied Health Research (InGef). Health research: methods. Available from: http://www.ingef.de/gesundheitsforschung/methoden/. Last accessed: February 2018.

Thursday, April 12, 2018

Liver Congress™ 2018 A third of bacterial infections in patients with cirrhosis across the world are multi-drug resistant

PARIS — Infections caused by multidrug-resistant bacteria, which are common in patients with cirrhosis, are associated with a significant elevation in risk for in-hospital mortality, results from a global study show.

A third of bacterial infections in patients with cirrhosis across the world are multi-drug resistant

European Association for the Study of the Liver

12 April 2018, Paris, France: A worldwide study initiated to investigate the epidemiology and outcomes of bacterial infections in hospitalized patients with liver cirrhosis has reported a prevalence of multi-drug-resistant (MDR) bacteria of 34% and significant regional differences in the risk of developing a multi-drug-resistant infection. Research teams from 46 centres across the world collaborated in this international study, which was promoted by the International Club of Ascites, the final results of which were presented today at The International Liver Congress™ 2018 in Paris, France.

Bacterial infections are common in patients with cirrhosis and are one of the most important causes of liver-related complications, progression of liver failure, and mortality in these patients.1 Multi-drug-resistant bacteria have emerged as a significant challenge in many countries,2 and infections caused by these bacteria are associated with a particularly poor prognosis in patients with cirrhosis.3

The study presented today in Paris included 1,302 hospitalized patients with cirrhosis and bacterial or fungal infections in North or South America (25%), Asia (32%) and Europe (43%). The most common infections identified were spontaneous bacterial peritonitis (SBP; 27%), urinary tract infection (UTI; 22%), and pneumonia (19%). A total of 740 patients (57%) had at least one positive culture and 959 microorganisms were isolated (58% gram negative, 38% gram positive, 4% fungi).

The global prevalence of MDR bacteria was reported to be 34% (95% CI 31, 37%), with the likelihood of having such an infection being higher in Asia (OR 2.79; p=0.017), particularly India (OR 7.94; p<0.001) or in South America (OR 2.23; p=0.053). In addition, use of antibiotics in the 3 months prior to hospitalization (OR 1.92; p=0.001), the category of infection (nosocomial: OR 2.65; p<0.001; healthcare-associated: OR 1.62; p=0.032) and the site of infection (pneumonia: OR 3.20; p<0.001; UTI: OR 2.48; p<0.001; skin and soft tissue: OR 2.92; p=0.004) were associated with an increased risk.

'Not surprisingly, we found a significantly lower rate of response to empirical antibiotic treatment in patients with infections caused by MDR bacteria compared with those due to non-MDR bacteria', said the authors of the presentation. 'We also saw a significantly higher incidence of shock and new organ failures, and a higher rate of in-hospital mortality among those with MDR bacterial infections'.

In light of these findings, they also stressed the urgent need to develop different empirical antibiotic strategies across different parts of the world. 'In the meantime, while we wait for new antibiotics to be developed, we must focus our efforts on reducing the spread of MDR bacteria among our patients with cirrhosis'.

'The finding that over one in three of bacterial infections occurring in hospitalized patients with cirrhosis are induced by multidrug resistance microorganisms is very worrisome', said Prof. Annalisa Berzigotti from the University of Bern, Switzerland, and EASL Governing Board Member. 'Awareness of this increasing problem is key in implementing the correct management procedures, such as the enhancement of hygiene measures (e.g. contact isolation), and to guide the choice of empiric antibiotic therapy in patients with a high risk of infection by MDR bacteria'.

References

14. Jalan R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310-24.

15. Acevedo J. Multiresistant bacterial infections in liver cirrhosis: clinical impact and new empirical antibiotic treatment policies. World J Hepatol. 2015;7(7):916-21.

16. Salerno F, et al. The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study. Liver Int. 2017;37(1):71-9.

https://www.eurekalert.org/pub_releases/2018-04/eaft-ato041218.php

Liver Congress™ 2018 Scotland: Direct-acting antiviral agent therapy reduces the burden of HCV-related decompensated cirrhosis

Related
Early-stage HCV treatment saves money, improves QOL
April 12, 2018
PARIS — Treating hepatitis C virus in the early stage of disease saves money in drug and medical costs while lowering risk for decompensated cirrhosis, hepatocellular carcinoma, liver transplant and liver-related death, according to a presentation at the International Liver Congress 2018.

“For all these outcomes, the best outcome is experienced by those who started at [fibrosis stage 0 and 1] and the worst by those who have advanced disease,” Scott Johnson, PhD, MHA, an economist with Medicus Economics LLC, said during a press conference. “The advanced patients have ten-sixteenths of the lifespan and quality of life of those who were treated when they were mild.”
Continue reading: https://www.healio.com/hepatology/hepatitis-c/news/online/%7Bbe1e33fe-348d-4b39-a390-05bee966a6d1%7D/early-stage-hcv-treatment-saves-money-improves-qol

Earlier HCV Tx May Lower Complication Rate, Save Money

PARIS -- Treating patients with hepatitis C virus (HCV) at earlier stages of fibrosis may be reduce both complications and cost, a commercially sponsored modeling study showed here.

There was a lower risk of decompensated cirrhosis, hepatocellular carcinoma, liver transplant, and liver-related death among patients who started treatment at the mild, F0-F1 stage compared to those who started treatment at advanced/compensated cirrhosis (F4/CC).
Continue reading: https://www.medpagetoday.com/meetingcoverage/easl/72308

Scotland: Direct-acting antiviral agent therapy reduces the burden of HCV-related decompensated cirrhosis 
European Association for the Study of the Liver

12 April 2018, Paris, France: Two presentations given this week at The International Liver Congress™ 2018 in Paris, France illustrate the impact that DAAs can have in averting HCV-related liver disease, and reducing the clinical and economic burden of this chronic infection. The first presentation summarized data from Scottish national records providing country-level evidence of a reduction in HCV-related decompensated cirrhosis since the introduction of DAAs in 2014. The second presentation described modelling data based on clinical trials of glecaprevir/pibrentasvir and UK patient tracker data, and suggested that the health and economic benefits of DAAs may be increased if treatment is initiated at an earlier stage of disease.

Rapid advances in the field of HCV treatment have led to the availability of several DAAs that now offer a cure, in the form of a sustained virological response (SVR), for more than 90% of people with chronic HCV infection.15,16 The impact of DAAs on the incidence and cost of liver morbidity and mortality at the population level is not yet known.17 Scotland is home to an estimated 34,500 people chronically infected with HCV and is regarded as a world leader in facing this problem.18 The Hepatitis C Action Plan (2006-2011) and the Sexual Health and Blood Borne Virus Framework (2011-2020)19 have resulted in significant increases in HCV diagnosis and treatment over the past decade.18-6 Informed by modelling work, Scotland set the ambitious target of reducing the incidence of HCV-related decompensated cirrhosis by 75% between 2015 and 2020.7,8

The Scottish HCV Clinical and Diagnosis databases, linked with the national inpatient hospital database, provided data on the use of HCV therapy up to March 2017 and on the numbers of patients with a chronic HCV diagnosis that had presented and been admitted to hospital for the first time with decompensated cirrhosis during 2000-2016. Among 4,800 people initiated on HCV therapy in Scotland between April 2014 and March 2017, 83% were treated with DAAs and 94% achieved SVR. This scale up of therapy, compared with the 3 preceding years, was associated with a 29% and 39% reduction in first-time presentations for decompensated cirrhosis among those previously diagnosed with chronic HCV and those with chronic HCV at the time of admission, respectively.

'Scotland's national surveillance of HCV treatment and disease means we are ideally placed to examine the early impact of DAA treatment on HCV-related disease progression at a population level', explained Professor Sharon Hutchinson from Glasgow Caledonian University, UK. 'We have been able to show that scale up of therapy has resulted in substantially fewer patients presenting with decompensated cirrhosis but has highlighted the need to address comorbidities that pose a continued risk of liver disease progression in those clear of the virus'.

In the second study, a health state transition model of the natural history of HCV was developed to forecast liver-related clinical and economic outcomes over a lifetime. The model population and treatment efficacy data were based on clinical trials of glecaprevir/pibrentasvir. Genotype, fibrosis distribution and costs were based on Scottish patient tracker data and on literature review. Rates of decompensated cirrhosis, hepatocellular carcinoma, liver transplant and liver-related death were predicted to be lower if treatment was initiated when disease was mild (F0-1) rather than delayed until compensated cirrhosis was present. As a consequence, early versus delayed treatment resulted in lower lifetime costs, including those associated with extrahepatic manifestations (F0-1: £33,297; compensated cirrhosis: £61,204), and greater lifetime quality-adjusted life years (F0-1: 16.20; compensated cirrhosis: 10.05).

'This study shows the impact that delayed treatment can have on a patient's life, including consequences such as liver morbidity and mortality, as well as extrahepatic complications', said Dr Sammy Saab, Professor of Medicine and Surgery at the University of California, Los Angeles. 'Beyond benefits to the patients, early treatment can generate significant savings by reducing clinical risks and allowing for a shorter, 8-week duration of treatment across all genotypes'.

'The studies from Scotland are important because they discuss the impact of HCV therapy and cure on patient-relevant outcomes', said Prof. Markus Cornberg from the Hannover Medical School, Germany, and EASL Governing Board Member. 'Recently, the value of DAA therapies has been challenged by a Cochrane review. These data are therefore very important in documenting not only sustained virological response, but also the prevention of morbidity and mortality'.

Author disclosures
Abstract 4515: Outside the submitted work: Sharon Hutchinson reports personal fees from Gilead Sciences; Hamish Innes reports personal fees from Gilead Sciences; John Dillon reports grants and personal fees from Gilead, Merck Sharp & Dohme, AbbVie, and Janssen; Peter Hayes reports personal fees from Merck Sharp & Dohme, Gilead, AbbVie, Janssen, Bristol-Myers Squibb, and Pfizer, and grants and personal fees from Roche; Raymond Fox is an Advisory Board member for AbbVie, Gilead, and Merck Sharp & Dohme, and reports personal fees from Gilead, AbbVie, and Merck Sharp & Dohme; Stephen Barclay reports personal fees from Gilead and Merck Sharp & Dohme, and grants and personal fees from AbbVie; Nicholas Kennedy is an Advisory Board member for AbbVie, Gilead, and Merck Sharp & Dohme, and reports personal fees from Gilead, AbbVie, and Merck Sharp & Dohme.

Abstract 1184: Design, study conduct and financial support for the study were provided by AbbVie, Inc. AbbVie Inc. participated in the interpretation of data, and review and approval of the abstract. All authors contributed to the development of the publication and maintained control over the final content. Brett Pinsky and Yuri Sanchez Gonzalez are employees of AbbVie Inc. and may own stocks and/or options in the company. Dominic Mitchell and Scott J Johnson are employees of Medicus Economics, LLC. Dominic Mitchell is a contractor to Medicus Economics, LLC. Medicus Economics, LLC received consulting fees for research from AbbVie. Sammy Saab is a consultant to and serves on speaker bureaus for AbbVie Inc., Bristol-Myers Squibb, Gilead, Janssen, and Merck.

References
15. World Health Organization. Global health sector strategy on viral hepatitis 2016-2021. June 2016. Available from: http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/. Last accessed: March 2018.

16. Scottish National Clinical Guidelines for the treatment of HCV in adults. Version 4.0, November 2017. Available from: http://www.hps.scot.nhs.uk/resourcedocument.aspx?resourceid=1598. Last accessed: March 2018.

17. Jakobsen JC, et al. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev. 2017;18:9.

18. The Hepatitis C Trust. Eliminating hepatitis C in Scotland: a call to action, 2018. Available from: http://www.hcvaction.org.uk/sites/default/files/resources/Eliminating%20Hepatitis%20C%20FINAL.pdf. Last accessed: March 2018.

19. Scottish Sexual Health and Blood Borne Virus Framework (2015-2020). Available from: http://www.gov.scot/Resource/0048/00484414.pdf. Last accessed: March 2018.

20. Hutchinson S, et al. Expansion of HCV treatment access to people who have injected drugs through effective translation of research into public health policy: Scotland's experience. Int J Drug Policy. 2015;26(11):1041-9.

21. Innes H, et al. Strategies for the treatment of hepatitis C in an era of interferon-free therapies: what public health outcomes do we value most? Gut. 2015;64(11):1800-9.

22. The Scottish Government hepatitis C treatment & therapies group report. Revised February 2017. Available from: http://www.gov.scot/Resource/0051/00515075.pdf. Last accessed March 2018.

For Patients: The International Liver Congress 2018

International Liver Congress

April 11, 2018 - April 15, 2018
Paris, France
Congress Website

Whether your liver is infected with a virus, injured by alcohol, or you have the most common liver disease in the United States - non-alcoholic fatty liver disease (NAFLD) - you need accurate information to make an intelligent decision about both treatment and care. From April 11-15, the 53rd annual meeting of the European Association for the Study of the Liver (EASL) will present key developments in the world of hepatology.

Viral Hepatitis & Fatty Liver Disease
Viral hepatitis highlights include; current and emerging treatments for hepatitis B virus (HBV), current data on effective drugs to treat hepatitis C virus (HCV), with research into the importance of early HCV treatment, follow up care, testing and linkage to care. As well as current research on liver cancer, alcoholic liver disease, fatty liver disease (information on screening, noninvasive tests, follow-up care, diet, and new drugs on the horizon), fibrosis, cirrhosis and liver transplantation.

Practice Guidelines
The European Association for the Study of the Liver (EASL) will also release four major clinical practice guidelines; hepatocellular carcinoma, decompensated cirrhosis, alcoholic liver diseases and updated recommendations on hepatitis C, view the guidelines below.

Download: Recommendations on Treatment of Hepatitis C 2018
April 11, 2018
EASL just released Updated EASL Recommendations on Treatment of Hepatitis C 2018.
*Shared by @HenryEChang via Twitter.

You can view the following guidelines online in the Journal of Hepatology;
EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Overview: EASL updates liver cancer guidelines at International Liver Congress
April 13. 2018
Liz Highleyman
The European Association for the Study of the Liver (EASL) presented updated clinical practice guidelines for the management of hepatocellular carcinoma (HCC) during a special session at the 2018 International Liver Congress yesterday ...


EASL Clinical Practice Guidelines on hepatitis E virus infection

Practice Guidelines - Download Slide Decks

Clinical Care Options
April 27, 2018
Practice-Changing Data From EASL 2018
Listen to downloadable audio from a live Webinar in which Stefan Zeuzem, MD, assessed the clinical impact of new data reported at the Paris meeting and answered case questions from participants.
Free Registration Required 

Conference News
April 28, 2018
On This Blog
Updates before, during and after the meeting.

Hepatitis C Treatment
May 17, 2018
HCV Next, May/June 2018
Nancy S. Reau, MD
As we in the United States look ahead to Digestive Disease Week coming up and further to our fall meetings, the International Liver Congress gives us an opportunity to…

May 4, 2018
Available online @ NATAP
Summary from EASL 2018 for Hepatitis C (HCV)
HCV in 2018: Success stories and remaining challenges?
With the more recent introduction of the pangenotypic regimens sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, two new fix dose combinations have become available which may even overcome the need for baseline HCV genotype assessment. Larger data sets however, from real-life cohorts still are missing but this gap has been filled at this year EASL.

May 1, 2018
Download HCV Advocates' May Newsletter
In this edition of the HCV Advocate we have devoted nearly the entire issue to the 2018 International Liver Congress. Lucinda Porter, RN and I cover some of our favorite posters and presentations in the current issue and in the upcoming June 2018 issue...

April 28, 2018
April "infohep bulletin" - Overview of EASL's 2018 International Liver Congress
Patients looking for an overview of EASL's 2018 International Liver Congress can find it in this month's "infohep bulletin".

International Liver Congress Sees Shift in Liver Diseases
I’ve been covering this conference since 2012, at the dawn of the era of direct-acting antivirals for hepatitis C. For about five years a large proportion of content—and the lion’s share of excitement—at this meeting was devoted to these new therapies.

April 21, 2018
Slides @ NATAP


Liver Fibrosis


Mavyret (glecaprevir/pibrentasvir)
The results of the first real-world studies assessing the effectiveness and safety of glecaprevir/pibrentasvir (G/P) in patients with chronic hepatitis C virus (HCV) infection have confirmed high rates of viral suppression and a favourable safety profile in patients receiving 8-16 weeks of treatment.

Commentary - Real-world experience confirms Mavyret efficacy in HCV
Two real-world studies presented at the International Liver Congress 2018 confirmed the efficacy and safety of Mavyret in Italy and Germany even in the face of multiple comorbidities.

Slides - Real-life effectiveness & safety of G/P among 723 Italian patients with chronic HCV: interim analysis of data from the NAVIGATOR-II study


NATAP Slides - FIRST REAL-WORLD DATA ON SAFETY AND EFFECTIVENESS OF GLECAPREVIR/PIBRENTASVIR FOR THE TREATMENT OF PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION: DATA FROM THE GERMAN HEPATITIS C-REGISTRY - (04/13/18)

Integrated Efficacy and Safety of Glecaprevir/Pibrentasvir in Patients With Psychiatric Disorders - (04/13/18)



RETREATMENT OF HEPATITIS C VIRUS INFECTION IN PATIENTS WHO FAILED GLECAPREVIR/PIBRENTASVIR - (04/12/18)

Time to Viral Suppression Does not Impact SVR in Patients Treated With Glecaprevir/Pibrentasvir for 8 Weeks - (04/23/18)

Clinical Care Options CCO - Review Capsules Summaries, download slides, and listen to audio commentary from expert-led Webinars covering critical studies on viral hepatitis.

Zepatier (elbasvir/grazoprevir)
Commentary - Zepatier Yields High Hepatitis C Cure Rates in U.S. Veterans
April 13, 2018
Cure rates were near 100 percent even though the population in the study’s analysis had high rates of other health conditions.




Effectiveness of Elbasvir/Grazoprevir in Patients with Cirrhotic Genotype 1 or 4 Chronic Hepatitis C: Updated Retrospective Data Analyses from the TRIO Network - (04/13/18)

Clinical Care Options CCO - Review Capsules Summaries, download slides, and listen to audio commentary from expert-led Webinars covering critical studies on viral hepatitis.
Second Interim Analysis of STREAGER: High Rate of SVR With 8 Weeks of Elbasvir/Grazoprevir in Treatment-Naive Patients With Nonsevere Fibrosis and Genotype 1b HCV Infection
Summary of Key Conclusions
In analysis of first 90 patients enrolled on a single-arm, open-label trial of treatment-naive patients with nonsevere fibrosis and genotype 1b HCV infection, 8 weeks of elbasvir/grazoprevir associated with sustained virologic response rate at 12 weeks post treatment (SVR12) of 97%
No grade 3/4 adverse events observed
Relapse observed in 4 patients (1 patient relapsed after achieving SVR12), including 1 patient with genotype 1e HCV infection wrongfully included in study

Harvoni (ledipasvir/sofosbuvir)
Slides @ NATAP
An eight-week course of sofosbuvir/velpatasvir (Epclusa) cured almost all people with hepatitis C genotype 3 without cirrhosis receiving treatment alongside opioid substitution therapy through community pharmacies or prisons in the Greater Glasgow area, Alison Boyle of Gartnavel Hospital, Glasgow, reported at the 2018 International Liver Congress in Paris on Thursday. Genotype 3 is especially common in people who inject drugs and former drug users. It has been considered 'harder to cure' although recent studies of newer agents in people with genotype 3 have shown high cure rates.

Clinical Care Options CCOReview Capsules Summaries, download slides, and listen to audio commentary from expert-led Webinars covering critical studies on viral hepatitis.
High SVR12 Rate With 8 Weeks of Sofosbuvir/Velpatasvir in Real-World Retrospective Analysis of Treatment-Naive Patients With Genotype 3 HCV and Fibrosis
Main Findings
In ITT population, 93% (84/90) of noncirrhotic, treatment-naive patients with genotype 3 HCV infection achieved SVR12 following 8 weeks of sofosbuvir/velpatasvir
Lost to follow-up: n = 2
Premature discontinuation: n = 2
Death: n = 1
Reinfection without subsequent spontaneous clearance: n = 1
In mITT population, 100% of patients achieved SVR12
High rates of SVR12 observed across selected subgroups
Subgroup, n/N (%)
SVR
ITT Population
mITT Population
F3 fibrosis
23/28 (82.1)
23/23 (100)*†‡§
HCV RNA > 6,000,000 IU/mL
5/6 (83.3)
5/5 (100)
HIV coinfected
2/3 (66.6)
2/2 (100)
Quantifiable HCV RNA at end of treatment
7/7 (100)
7/7 (100)
Daily supervised methadone
35/38 (92.1)
35/35 (100)†‡
IVDU
8/8 (100)
8/8 (100)
Non-IVDU
14/15 (93.3)
14/14 (100)
Positive screen for drugs of abuse
4/4 (100)
4/4 (100)

Clinical Care Options CCO
Addition of RBV Associated With Increased Efficacy of 12 Weeks Sofosbuvir/Velpatasvir in Patients With Genotype 3 HCV Infection and Compensated Cirrhosis
Summary of Key Conclusions
In NS5A-naive patients with genotype 3 HCV infection and compensated cirrhosis, sustained virologic response at 12 weeks posttreatment (SVR12) rate numerically higher in those receiving sofosbuvir (SOF)/velpatasvir (VEL) with ribavirin (RBV) vs SOF/VEL alone
SVR12 rate 96% vs 91%, respectively
Fewer relapses observed with use of RBV
In both treatment arms, NS5A resistance associated substitutions (RAS) at baseline associated with reduced SVR12 rate, particularly Y93H
Treatment well tolerated
Few grade 3/4 adverse events (AEs), serious AEs, discontinuations for AEs in both treatment arms
Use of RBV associated with increased toxicities


Safety and Efficacy of Sofosbuvir/Velpatasvir with and without Ribavirin in Genotype 3 HCV-Infected Patients with Cirrhosis - (04/13/18)

Vosevi (Sofosbuvir/Velpatasvir/Voxilaprevir) 
Clinical and virological characteristics of DAA-experienced patients with chronic HCV infection treated with sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX): results from the Frankfurt Resistance Database - (04/20/18)

Ravidasvir combined with sofosbuvir
Video Healio:
$300 HCV combination reaches 97% cure rates in Malaysia, Thailand
April 13, 2018
PARIS — Using a new medication and generic sofosbuvir, researchers reached 97% sustained virologic response in patients with hepatitis C both with and without…

Commentary - New affordable hepatitis C combination shows 97% cure rate
April 12, 2018
The combination of sofosbuvir and the new NS5A inhibitor ravidasvir cured 97% of people with hepatitis C in a study carried out in Malaysia, and could provide a safe and effective cure for hepatitis C in low- and middle-income countries for $300 or less, researchers of the Drugs for Neglected Diseases Initiative reported on the opening day of the 2018 International Liver Congress in Paris.

April 12, 2018
New affordable hepatitis C combination treatment shows 97% cure rate
An affordable hepatitis C combination treatment including the new drug candidate ravidasvir has been shown to be safe and effective, with extremely high cure rates for patients, including hard-to-treat cases, according to interim results from the Phase II/III STORM-C-1 trial presented by the non-profit research and development organisation Drugs for Neglected Diseases initiative (DNDi) at the International Liver Conference in Paris.

Commentary - The Latest Hepatitis C News From the 2018 International Liver Congress
April 13, 2018
By Lucinda K. Porter, RN
The 2018 International Liver Congress (ILC) began yesterday in Paris. This annual meeting is hosted by the European Association for the Study of the Liver (EASL). It is an important event for liver specialists, and people gather from all over the world to share their latest findings. In the next week, I’ll post more frequently with highlights from some posters and presentations. (Note: Conference presentations represent part of the story and unless and until these studies are published in a peer-reviewed journal, these data and conclusions are considered preliminary.)

Treat Early
(at earlier stages of fibrosis)
EASL Press Release - Liver Congress™ 2018 Scotland: Direct-acting antiviral agent therapy reduces the burden of HCV-related decompensated cirrhosis
April 12, 2018
Two presentations given this week at The International Liver Congress™ 2018 in Paris, France illustrate the impact that DAAs can have in averting HCV-related liver disease, and reducing the clinical and economic burden of this chronic infection.

Slides @ NATAP
EASL: Early versus Delayed Hepatitis C Treatment Provides Increased Health Benefits at Lower Costs: A Pan-Genotypic Cost-Effectiveness Analysis Set in Scotland -

The early treatment of hepatitis C infection with a pan-genotypic drug combination is more effective and less expensive than if therapy is delayed until liver fibrosis develops, health economists report. A health state-transition model of the natural history of hepatitis C shows that early therapy with the combination of glecaprevir and pibrentasvir (Mavyret, AbbVie) results in lower lifetime costs because of reductions in the risk for decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related mortality, said researcher Scott Johnson, PhD, from Medicus Economics in Boston.

Commentary - Early-stage HCV treatment saves money, improves QOL
April 12, 2018
Treating hepatitis C virus in the early stage of disease saves money in drug and medical costs while lowering risk for decompensated cirrhosis, hepatocellular carcinoma, liver transplant and liver-related death.

Commentary - Earlier HCV Tx May Lower Complication Rate, Save Money
April 12, 2018
PARIS -- Treating patients with hepatitis C virus (HCV) at earlier stages of fibrosis may be reduce both complications and cost, a commercially sponsored modeling study showed here. There was a lower risk of decompensated cirrhosis, hepatocellular carcinoma, liver transplant, and liver-related death among patients who started treatment at the mild, F0-F1 stage compared to those who started treatment at advanced/compensated cirrhosis (F4/CC).

Cirrhosis
NATAP Slides

Commentary - DAA therapy effective in patients with HCV and advanced cirrhosis
April 16, 2018
PARIS — Direct-acting antiviral therapy effectively treated hepatitis C virus in patients with high MELD scores, producing a high rate of…
Slides @ NATAP - Direct Acting Antiviral HCV Therapy is Safe and Effective in Patients with Decompensated Cirrhosis: Real World Experience from the HCV-TARGET Cohort - (04/12/18)

EASL Press Release - Liver Congress™ 2018 - Mediterranean-style diet improves gut microbial diversity reduces hospitalization in liver cirrhosis
April 12, 2018
'Our hypothesis for this study was that diet and the severity of cirrhosis might interact to determine microbiota composition and, ultimately, clinical outcomes in patients with liver cirrhosis'.

Press Release - Liver Congress™ 2018 A third of bacterial infections in patients with cirrhosis across the world are multi-drug resistant 
April 12, 2018
'The finding that over one in three of bacterial infections occurring in hospitalized patients with cirrhosis are induced by multidrug resistance microorganisms is very worrisome', said Prof. Annalisa Berzigotti from the University of Bern, Switzerland, and EASL Governing Board Member.

Commentary - 'Alarming' New Numbers on Bacterial Infection in Cirrhosis
April 12, 2018
PARIS — Infections caused by multidrug-resistant bacteria, which are common in patients with cirrhosis, are associated with a significant elevation in risk for in-hospital mortality, results from a global study show.

Liver Transplant
April 15. 2018
Therapies also appear to reduce liver-related mortality
Since use of direct acting antiviral combination therapies for hepatitis C virus (HCV) infection became widespread, the need for liver transplantation for patients with the infection has plummeted, researchers reported here.

Scale-up of HCV diagnosis and treatment
EASL Press Release - Linkage to care specialist facilitates access to HCV treatment for people who inject drugs
April 12, 2018
'Based on our analysis', said Sarah Robbins from the Polaris Observatory, 'we predict that given the current standard of care for the next 15 years, the total HCV-infected population in Europe would increase by an estimated 1% by 2030 and that, in order to meet WHO goals, the number of individuals diagnosed annually would need to increase to at least 800,000 by 2022, with 900,000 being treated each year by 2025. Improving linkage to care coupled with increased access to DAA therapy is needed to achieve such goals'.


Liver Cancer
Liver-related & HCC events were rare after up to 144 weeks of follow-up in patients with F2-F3 fibrosis who had achieved SVR with DAA therapy: Results from the Gilead Sciences SVR Registry


Slides @ NATAP
Commentary - EASL updates liver cancer guidelines at International Liver Congress
Liz Highleyman
The European Association for the Study of the Liver (EASL) presented updated clinical practice guidelines for the management of hepatocellular carcinoma (HCC) during a special session at the 2018 International Liver Congress yesterday ...

April 12, 2018
'HCC surveillance in HCV patients after sustained virological response is a matter of debate', said Prof. Markus Cornberg from the Hannover Medical School, Germany, and EASL Governing Board Member. 'This study is important because it emphasizes the importance of HCC surveillance by ultrasound in patients with cirrhosis, even if HCV has been eliminated. However, the study also challenges the need for surveillance in patients with advanced fibrosis but without cirrhosis'.

Video Healio:
April 13, 2018
“Long-term follow-up studies and data will be required to identify those who are at risk for tumor development and also to better tailor surveillance guidelines,” Zangneh concluded. – by Talitha Bennett
April 12, 2018
Celsion’s Phase III OPTIMA Study is expected to enroll up to 550 patients in up to 70 clinical sites in the United States, Europe, China and Asia Pacific, and will evaluate ThermoDox® in combination with optimized RFA, which will be standardized to a minimum of 45 minutes across all investigators and clinical sites for treating lesions three to seven centimeters, versus optimized RFA alone.

WHO’s 2030 hepatitis C elimination goals
April 12, 2018
New research presented at this year’s International Liver Congress in Paris, France (11-15 April) shows that while several European countries are now on target to meet WHO’s 2030 hepatitis C elimination goals, many others are off track and problems screening and diagnosing enough patients threaten the progress of all countries.

Hepatitis B
Press Release - Assembly Biosciences Presents Positive Interim Data from Phase 1a and 1b Studies of ABI-H0731 in HBV Patients in a Late-Breaker Session at the EASL Conference
April 12, 2018
The Phase 1b patient study enrolled both HBeAg positive and negative patients. Potent antiviral activity was observed across patient cohorts in a dose dependent manner. Specifically, in the ongoing 300 mg dose cohort, the mean overall decline from baseline is currently ≥2.8 log10 IU/mL, with ≥2.9 and 2.5 log10 IU/mL mean declines in HBeAg positive and negative patients, respectively. Maximal viral load declines of 3.6 to 4.0 log10 IU/mL were observed in certain HBeAg negative patients treated at all dose levels (100 to 400 mg). The company intends to report complete results from this study at a scientific conference later this year.

Slides @ NATAP

View all HBV coverage at NATAP

Fatty Liver Disease: NAFLD/NASH




April 13, 2018
'We demonstrated that German patients with NAFLD/NASH who develop compensated cirrhosis have a substantial burden of comorbidities and that their healthcare costs jump with the development of cirrhosis', said Dr Canbay. 'Novel treatment options are needed to improve patient outcomes'. 'This study highlights the burden of NASH cirrhosis on healthcare systems and reinforces the need for new therapies to tackle the epidemic currently affecting many European countries', said Prof. Phil Newsome from the Queen Elizabeth Hospital and University of Birmingham, UK, and EASL Governing Board Member.

Press Release - Gilead Presents Data on Multiple Investigational Regimens for the Treatment of Patients With Nonalcoholic Steatohepatitis (NASH) and Advanced Fibrosis at The International Liver CongressTM 2018
Gilead Presents Data on Multiple Investigational Regimens for the Treatment of Patients With Nonalcoholic Steatohepatitis (NASH) and Advanced Fibrosis at The International Liver CongressTM 2018

Commentary - Low food security increases risk for advanced fibrosis
Food insecurity an increased risk for advanced fibrosis, particularly among patients with diabetes, according to a presentation at the International Liver Congress 2018. According to a presentation by Russell Rosenblatt, MD, from the New York Presbyterian Hospital, food insecurity is the state of being without reliable access to a sufficient quantity of affordable, nutritious food, often in the form of low-cost, energy-dense, nutritionally poor foods. “Food insecurity’s risk for diabetes doesn’t stop there,” Rosenblatt said. “We know that diabetes increases the risk for NAFLD, and diabetes is also an increased risk factor for advanced fibrosis.”

April 13, 2108
Deep-learning approaches to pattern recognition in liver biopsy samples have moved one step closer to clinical application, with a new study reporting a good correlation between an automated image analysis system and an expert reviewer for the identification of key markers of disease activity in a pre-clinical model of non-alcoholic steatohepatitis (NASH).

April 13, 2018
presented the positive results from the interim analysis of the Phase 2 clinical trial of MN-001 (tipelukast) in NASH (non-alcoholic steatohepatitis) and NAFLD (non-alcoholic fatty liver disease) with hypertriglyceridemia

April 12. 2018
The research demonstrated that adding fructose (sugar) and fatty acids to three-dimensional bioprinted human liver tissue produced NASH-type liver pathology, including steatosis, inflammation, ballooning and fibrosis. Addition of MSDC-0602K to the tissue showed evidence of reduced disease progression, including reductions in collagen deposition and stellate cell activation, in the liver model.

Commentary - Cenicriviroc shows safe long-term antifibrotic activity in adults with NASH
April 12, 2018
PARIS — Cenicriviroc, an oral C-C chemokine receptor type 2 and type 5 antagonist also known as CVC, was well-tolerated and provided…

April 11, 2018
Two independent studies have today reported that alcoholic liver disease has now replaced hepatitis C virus (HCV) infection as the leading cause of liver transplantation in the USA in patients without HCC. Non-alcoholic steatohepatitis (NASH) is also on the increase, now ranking second as a cause of liver transplantation due to chronic liver disease.

Primary sclerosing cholangitis
April 13, 2018
'Studies like this one are key, since they investigate possible novel treatments for PSC, a disease that currently has no effective therapies', said Prof. Marco Marzioni from the University Hospital of Ancona, Italy, and EASL Governing Board Member. 'Although this trial did not achieve fully positive results in terms of reduction of markers of disease progression, it certainly indicates that the manipulation of key molecules involved in the pathophysiology of PSC is the route to cure for our patients'.

April 12, 2018
PARIS — Patients with primary sclerosing cholangitis who took statins – likely for another indication – showed reduced risk for transplant and morbidity, according to a presenter at the International Liver Congress 2018. - View Press Release

April 10, 2018
Animated short created to raise public awareness about liver failure European Association for the Study of the Liver
The ad highlights the innovative DIALIVE technology, a novel 'liver dialysis device' which after 25 years of research is undergoing two clinical trials which will assess its safety and efficacy. View the ad, here..... Press release, here....

Healio live from EASL’s 2018 International Liver Congress
Guidelines, Expanded Opportunities Mark EASL's Liver Congress
Liver Cancer on the Rise in Backdrop of Undiagnosed Hep C

Conference Coverage

Websites
Link: Practice Point 
Independent Conference Coverage from the 53rd Annual Congress of the European Association for the Study of the Liver (EASL)*
In this video series, Dr. Brown will present ‘what you need to know in 5‐minutes’ regarding today's presentations from The International Liver Congress EASL 2018 in Paris, France. 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 conference.
Free registration required

To learn more, or view highlights see: Liver Congress 2018 - ‘what you need to know in 5-minutes’ video clips each day from the conference

EASL LiverTree - Open To All
This year webcasts and congress materials are open access! Watch freely the conferences and ePosters
*Free registration required

Link: NATAP
The National AIDS Treatment Advocacy Project - NATAP
Slide decks, press updates, commentary, and full-text articles
About NATAP

Link: Healio
Coverage of the meeting will include, videos, perspectives and interviews with leading researchers and clinicians.
About Healio

Link: infohep
Patient-friendly coverage

News, with patient-friendly commentary
About NAM

Link: MedPage Today
Commentary and news updates

Link: Medscape 
Read clinically focused news coverage of key developments from ILC 2018.
*Free registration may be required
About Medscape

Link: Clinical Care Options CCO
Review Capsules Summaries, download slides, and listen to audio commentary from expert-led Webinars covering critical studies on viral hepatitis and NAFLD/NASH from Paris.About CCO

Link: Liz Highleyman @ Cancer Health

Newsletters
Link: HCV Advocate
Download HCV Advocate's - May Newsletter
In this edition of the HCV Advocate we have devoted nearly the entire issue to the 2018 International Liver Congress. Lucinda Porter, RN and I cover some of our favorite posters and presentations in the current issue and in the upcoming June 2018 issue...

Blogs
HCV Advocate Greg Jefferys blogs from the conference.
Inside the convention hall were display stands for Zepatier, Mavyret and Epclusa and many other products related to treating liver diseases. The three DAA stands were by far the biggest but Gilead easily won the “Biggest and Most Number of display stands” award with three huge and separate stands.

Follow On Twitter
@EASLnews
@HenryEChang 
@JMPawlotsky 
@DonaldJensenMD
Liz Highleyman‏ @LizCancerHealth
@Homie_Razavi
@rixwolff
@JVLazarus
@HepatitisEurope

Abstract Book
Start by reviewing the first abstracts of the meeting, and embargo policy, available online and shared via Twitter by Henry E. Chang.
Download Here: https://jumpshare.com/v/rz9OhagvCF0FEPy7zwHQ

HEPAHEALTH Project Report
EASL report on the burden of liver disease across Europe
April 12, 2017
Link: Watch - Liver Congress™ 2018 - First Press Conference HEPAHEALTH Project Report
The European region is the highest consumer of alcoholic beverages in the world and efforts to reduce alcohol consumption are stalling in many countries. Likewise, rates of obesity have risen across almost every country the report surveyed since 2013 and the rates of Non-Alcoholic Fatty Liver Disease (NAFLD) are increasing accordingly. In Southern and Eastern Europe viral hepatitis is the leading cause of liver disease mortality.
Twitter #Hepahealth

Watch - Daily Press Conference

*Page updated May 5, 2018