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Top stories from ILC 2022: Hepatitis outbreak, elimination


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Here are Healio’s top peer-tested stories from the International Liver Congress 2022, which highlight updates on the outbreak of acute hepatitis in children, hepatitis elimination strategies, antiviral combinations and more.

 

Acute hepatitis outbreak swells to nearly 900 cases; global data shows ‘mixed picture’

An outbreak of acute, severe hepatitis of unknown etiology in children has grown to 894 cases across 33 countries, according to data presented during a media briefing.

“As of June 20, we now have 894 probable cases reported in 33 countries in five WHO regions,” Philippa Easterbrook, MD, senior scientist at the Global HIV, Hepatitis and STI Programs at WHO headquarters in Geneva, told attendees. “Since the last WHO public communication on May 27, this represents 244 additional cases over a space of about a month. However, it’s important to remember that this includes both new cases as well as retrospectively identified cases.” Read more.

WHO: HCV elimination by 2030 demands ‘scale-up, simplification’ of care pathways

WHO presented updated guidance on hepatitis C, calling for drastic simplification of care pathways to alleviate access gaps in HCV testing and treatment, during a joint WHO-EASL-CDC symposium.

“In 2016, when WHO launched its global strategy, there were ambitious plans for elimination, defined as a 90% reduction in incidence and a 65% reduction in mortality,” Philippa Easterbrook, MD, said. “These could be delivered through the scale-up of six synergistic interventions, including testing and treatment, to achieve by 2030 towards elimination: 90% of those infected diagnosed, and 80% of those diagnosed treated.” Read more.

Antiviral combination plus standard therapy achieves ‘controlled biological state’ in HBV

Therapy combining small interfering RNA, capsid assembly modulator and nucleotide analogue reduced HBsAg levels over 24 weeks compared with standard therapy, according to a presenter.

“It’s important that we think about public health and global viruses and liver disease, and hepatitis B is a globally relevant virus,” Kosh Agarwal, MD, from the Institute of Liver Studies at King’s College Hospital in London, told attendees. “I believe the latest estimates suggest that almost 300 million people in the world are affected with hepatitis B, and almost every 30 seconds, someone dies of hepatitis B somewhere in the world.” Read more.

PPIs linked to risk for severe infection, decompensation in patients with cirrhosis

Exposure to proton pump inhibitors correlated with an increased risk for severe infection and cirrhosis decompensation among a subset of patients with cirrhosis, according to research presented.

“The safety of PPIs in cirrhosis remains quite controversial,” Nadim Mahmud, MD, MS, MPH, MSCE, assistant professor of medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine, said. “There is conflicting data regarding the impact of PPIs on several key liver-related adverse events, including infections, decompensation and mortality. There is plausibility to this potential association. … However, prior studies are limited.” Read more.

Givosiran increases quality of life, reduces attacks in acute hepatic porphyria

Long-term givosiran treatment provided sustained benefit and improved quality of life among patients with acute hepatic porphyria, according to a presenter.

“Acute hepatic porphyria is a rare genetic disorder that causes acute neurovisceral symptoms caused by defects in hepatic heme biosynthesis leading to accumulation of neurotoxic heme intermediates 5-aminolevulinic acid and porphobilinogen, which can be life-threatening in a small proportion of patients. It can also lead to chronic debilitating symptoms in a subtype of patients,” Manish Thapar, MD, director of the Center for Genetic and Metabolic Liver Disease at Thomas Jefferson University, said during the press conference. “In this meeting, we will be presenting data from a long-term study of a novel treatment called givosiran, which has been approved and is commercially available.” Read more.

Alcohol use disorders may drive HCC progression in patients with diabetes

Alcohol misuse was a primary trigger for progression of liver disease to hepatocellular carcinoma among a subset of French patients with type 2 diabetes, according to data presented.

“A history of alcohol use disorders accounted for more than half of the HCC burden of patients with type 2 diabetes in France from 2011 to 2020,” Lucia Parlati, a PhD student at the Cochin Institute in Paris, said. “Male patients with type 2 diabetes, aged between 65 and 70, with a history of alcohol use disorders were at a higher risk of HCC.” Read more.

NAFLD, alcohol-associated liver disease spur rise in global liver cancer deaths

Nonalcoholic fatty liver disease and alcohol-associated liver disease are among the main contributors of increased mortality related to chronic liver disease and liver cancer burden, according to research.

“Although viral hepatitis B and C and alcohol liver disease have historically been the drivers of burden of chronic liver disease and liver cancer, NAFLD and nonalcoholic steatohepatitis have increasingly become more prominent,” Zobair Younossi, MD, MPH, president of Inova Health System Center for Liver Diseases, said. “The most recent meta-analysis suggests that the global prevalence of NAFLD is 29%, and in 2020 NAFLD was the second indication for all liver transplants in the U.S.” Read more.



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