Urgent Elimination of Viral Hepatitis Prioritized on World Hepatitis Day

On Friday, clinicians and researchers across the world recognized World Hepatitis Day as an opportunity to honor the “more than a million lives lost to hepatitis” every year and redouble national efforts to stop its spread.

Every year on July 28th, awareness campaigns spotlight viral hepatitis as a leading cause of global death, branded as a “hidden epidemic” earlier this year by President Joe Biden.

This year’s theme — “We’re not waiting” — is a call for accelerated efforts to eliminate viral hepatitis, and to get testing and treatment “for the real people who need it,” according to the World Hepatitis Alliance.

In honor of World Hepatitis Day, Healio has gathered a list of the latest research on viral hepatitis, including how global efforts have succeeded in improving outcomes for patients with hepatitis, and where efforts are still needed to address gaps in hepatitis treatment and testing access.

Bulevirtide induces a virologic, biochemical response in chronic hepatitis D

Bulevirtide was safe and increased the proportion of patients with undetectable hepatitis D virus RNA among those in both the 2 mg and 10 mg dosage groups, according to data published in The New England Journal of Medicine.

The results were also presented during the EASL Congress. Read more.

HCV elimination represents ‘win-win-win’ for patients, public health, cost savings

Every year nearly 3 million patients are diagnosed with hepatitis B and C infections, ultimately leading to 1.1 million deaths worldwide, WHO reported.

In response to this immense public health burden, WHO and other international organizations have developed goals and plans for elimination. Although implemented by most countries with many on track to reach their goals, analyses have revealed a persistent reservoir of chronic hepatitis viruses and new infections remain a threat, Sheikh Mohammad Fazle Akbar, MD, PhD, and colleagues wrote in Infectious Diseases & Immunity. In the U.S., only 6% of states are on track to achieve HCV elimination by 2030, according to a 2020 report by Mark Sulkowski, MD, and colleagues. Researchers further reported 35% of states are not expected to meet their margins by 2040. Read more.

Treating hepatitis C ‘feasible’ in patients with HCC, improves overall survival

Failure to achieve sustained virological response and the presence of more advanced chronic liver disease were associated with mortality in patients with hepatitis C and hepatocellular carcinoma, according to a researcher at EASL Congress.

“It is well known that achieving a sustainable virological response after hepatitis C treatment reduces liver decompensation and HCC development with a positive impact on the overall survival,” Maria Fernanda Guerra Veloz, MD, PhD, of the Institute of Liver Studies at King’s College London, said. “All of these benefits in the reduction of liver-related morbidity/mortality and no liver-related mortality were already described in the interferon era and have resisted since across the whole spectrum of the disease with a direct-acting antiviral therapy.” Read more.

Controlling HCV: ‘The time for political action is here’

In 2015, WHO initiated a campaign to eliminate hepatitis B and C worldwide.

Why did WHO target these infections? Viral hepatitis and its consequences represent the 7th leading cause of global deaths — more than 1.5 million in 2015 — with 95% due to hepatitis B and C. This exceeds deaths from malaria, HIV and tuberculosis and is the only one in which the death rate is increasing. Read more.

1 in 10 patients with advanced liver disease develops liver-related event after HCV cure

The risk for hepatic decompensation and hepatocellular carcinoma remained constant after hepatitis C virus cure among patients with advanced chronic liver disease, underscoring the need for post-HCV risk stratification in the long term.

“Currently, more than 1 million individuals are being treated every year for hepatitis C virus; therefore, we need proper risk stratification to decrease resource utilization,” Georg Semmler, MD, of the division of gastroenterology and hepatology at the Medical University of Vienna, said at EASL Congress. “Compensated advanced chronic liver disease, also commonly known as compensated cirrhosis, is the target population for risk stratification tools because these patients are at risk to develop complications such as hepatic decompensation or hepatocellular carcinoma.” Read more.

Women, younger injection drug users have a higher risk for HIV, HCV

Results from a systematic review and meta-analysis demonstrated greater risk for hepatitis C virus and HIV infection among women and younger people who inject drugs, according to data reported in The Lancet Gastroenterology & Hepatology.

“Globally, around 18% of people who inject drugs (PWID) are living with HIV and more than 50% have been infected with HCV,” Adelina Artenie, PhD, of the department of population health sciences at Bristol Medical School in the United Kingdom, and colleagues wrote. “Over the past two decades, the incidence rates of HIV and HCV have declined among PWID in some high-income countries (HICs). … Meanwhile, persistently high levels or outbreaks of HIV and HCV among PWID have been reported in other HICs and low-income or middle-income countries (LMICs).” Read more.

Lowering HCC incidence threshold in guidelines cost-effective, may improve early detection

Research demonstrated that hepatocellular carcinoma surveillance is cost-effective at a lower incidence threshold of 0.7% in virologically cured patients with hepatitis C virus, underscoring the need to update clinical guidelines.

“Hepatitis C treatment represents cure, but some patients remain at risk of developing HCC, the most common form of liver cancer,” Jagpreet Chhatwal, PhD, director of the Institute for Technology Assessment at Massachusetts General Hospital and associate professor at Harvard Medical School, told Healio. “Clinical guidelines recommend routine screening for HCC if the annual incidence of HCC exceeds 1.5%. This recommendation is based on old data; therefore, we investigated the contemporary incidence threshold above which routine HCC screening is cost-effective.” Read more.

Lower diagnostic costs needed for HBV peripartum antiviral prophylaxis to be effective

The addition of peripartum antiviral prophylaxis to reduce neonatal hepatitis B virus infection could have “substantial extra health benefits,” although decreased diagnostic costs are needed to make this strategy cost-effective.

“WHO’s Global Health Sector Strategy on Viral Hepatitis set a target for elimination of mother-to-child transmission of HBV, with the aim to reach a prevalence of less than 0.1% in children younger than 5 years by 2030,” Shevanthi Nayagam, PhD, a clinical fellow in the School of Public Health at Imperial College London, and colleagues wrote in The Lancet Gastroenterology & Hepatology. “The primary recommendation to accomplish this target has been the use of a birth dose of HBV vaccine given to the neonate within 24 hours of birth (HepB-BD), and a further two or three vaccine doses usually given to the infant as part of the Expanded Program on Immunizations.” Read more.

Adenovirus re-emerges as likely culprit in 2022 outbreak of acute hepatitis in children

A 2022 outbreak of unexplained acute severe hepatitis in children has been linked to a strain of adeno-associated virus 2, supporting the theory that disease pathogenesis results from viral coinfection, according to data reported in Nature.

Since October 2021, more than 1,300 children in 35 countries have developed acute severe hepatitis of unknown etiology, with the United States and the United Kingdom accounting for 65% of global cases, according to recent WHO data. Read more.

Mycophenolate mofetil induces remission in nearly 60% with autoimmune hepatitis

Mycophenolate mofetil was superior to azathioprine in achieving biochemical remission in treatment-naive patients with autoimmune hepatitis who were also treated with prednisolone, according to data presented at EASL Congress.

“First line treatment [of autoimmune hepatitis] consists of the combination of azathioprine with prednisolone, and these recommendations are based on clinical trials executed in the ’60s and ’70s,” Romée JALM Snijders, MD, a PhD candidate in the department of gastroenterology and hepatology at Radboud University Medical Center in the Netherlands, said. “Mycophenolate mofetil (MMF) has emerged as an alternative option to azathioprine. … MMF has shown particularly favorable outcomes in patients intolerant to azathioprine and prospective studies have shown good results and promising results regarding the efficacy and safety of MMF.” Read more.

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