Coming soon: news from the Digital International Liver Congress

The Digital International Liver Congress (EASL 2020) takes place this year between 27 and 29 August.

Infohep will be publishing news from the Congress from 28 August onwards.

Check back regularly at infohep for news on viral hepatitis from the Congress.

EASL updates guidance on COVID-19 in liver disease patients

The European Association for the Study of the Liver (EASL) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) have updated their guidance on chronic liver disease and COVID-19, issued in April 2020, to reflect emerging evidence.

They stress that people with chronic liver disease are not at increased risk of infection with SARS-CoV-2, but if they develop COVID-19, some people with liver disease may have a more severe illness.

People with metabolic-associated fatty liver disease, also known as non-alcoholic fatty liver disease, appear to have more severe COVID-19 and this is correlated with the presence of non-invasive fibrosis. However, EASL and ESCMID say that larger analyses are needed to be certain that metabolic-associated fatty liver disease leads to worse COVID-19 outcomes.

No strong evidence has emerged to show that viral hepatitis is associated with worse COVID-19 outcomes.

EASL and ESCMID say that people with cirrhosis are particularly vulnerable if they become infected with SARS-CoV-2. They have a higher risk of death than people without cirrhosis if they develop COVID-19 illness and should be admitted to hospital sooner than other COVID-19 patients.

Is hepatitis elimination feasible by 2030?

Major gaps in hepatitis elimination efforts throughout the world threaten achievement of the World Health Organization (WHO) targets for achieving substantial reductions in new infections and deaths due to viral hepatitis by 2030, experts write in Nature Reviews Gastroenterology & Hepatology, in a Viewpoint article published to coincide with World Hepatitis Day.

In 2016, WHO member states agreed to work towards elimination of hepatitis B and C by 2030. Specifically, they set targets of reducing deaths from hepatitis B and C by 65%, by diagnosing 90% of infections and treating 65% of eligible people, as well as preventing 90% of infections.

Elimination requires investment, experts agreed. Viral hepatitis could be eliminated in 67 lower- and middle-income countries by 2030 with an investment of $58.7 billion.

Efforts are hindered by a lack of national elimination strategies to mobilise resources and co-ordinate activity. A 2017 survey by WHO found that only 84 out of 135 countries had developed a national plan and just 49 had dedicated funding to hepatitis elimination.

Other gaps identified by hepatitis experts include:

  • Very low rates of diagnosis (only 9% of hepatitis B infections are estimated to have been diagnosed worldwide).
  • Lack of implementation of key interventions recommended by WHO, especially hepatitis B birth dose vaccination.
  • Lack of access to diagnostic testing or affordable treatment.
  • Lack of donor-supported funding mechanisms to support elimination efforts in lower- and middle-income countries.

Read the full article on infohep to find out how money and efforts should be invested to achieve the elimination goals.

COVID-19 slows hepatitis elimination

Hepatitis elimination efforts are being severely affected by the COVID-19 pandemic in many settings, results of a 32-country survey by the World Hepatitis Alliance show.

The survey of civil society hepatitis organisations and frontline providers, carried out between 30 March and 4 May 2020, sought responses from World Hepatitis Alliance member organisations and stakeholders.

A total of 132 people representing organisations in 32 countries responded. Approximately half of responses came from the United States.

Ninety-four per cent of respondents said that their hepatitis services had been affected by COVID-19. Lack of access to testing facilities was a frequent problem, reported by almost two-thirds. Forty-six per cent said that facilities were closed but two-thirds said that people were avoiding testing facilities due to fear of COVID-19 infection.

Treatment for hepatitis is also being affected, especially outside the United States. Around half of respondents from lower- and middle-income countries reported lack of access to medication since the onset of the pandemic. In India and Nigeria, respondents reported that travel restrictions were preventing people from obtaining medication.

However, avoidance of healthcare facilities due to COVID-19 was also cited by more than half of respondents in lower- and middle-income countries as a reason for lack of access to medication.

Redeployment of services and healthcare staff to fight COVID-19 was cited as another important reason for reductions in testing activity and medication access.

Condomless sex sufficient to pass on hepatitis C between men

Hepatitis C transmission during anal sex can take place without bleeding, trauma or sharing of injecting equipment and exposure to semen is likely to be enough for the virus to be passed on, investigators in the United States report in the journal PLOS ONE.

The conclusions come from an intensive investigation of ten cases of recent hepatitis C infection in eight gay men living with HIV.

The new study, led by Dr Hui Li of Perelman School of Medicine, University of Pennsylvania, used single genome sequencing and interviews with each of the men to establish the potential source of infection, asking them to recall their sexual and drug-using practices in recent sexual encounters.

Single genome sequencing takes a single virus and analyses its entire DNA sequence. This technique has been used in HIV research to demonstrate that the genetic diversity of infecting viruses increases when there is more damage to the mucosal barrier in the vagina or rectum.

In this study, the investigators hypothesised that if men infected with hepatitis C had only one virus genetic pattern detectable in multiple viruses sampled soon after infection, this showed a lack of damage to the mucosal barrier in the rectum.

In turn, this would signal a lower likelihood that rectal bleeding was necessary for transmission to take place. A lack of viral diversity would also show a lack of transmission through injecting drug use (where many genetically diverse viruses are transmitted).

The researchers conclude that eight out of ten infections were attributable to a single virus, occurred without rectal trauma and were not associated with injecting.

Hepatitis C prevention messages for gay men should clarify the potential for transmission, the study authors say. “Intra-rectal exposure to semen during condomless anal intercourse is therefore likely sufficient for hepatitis C virus transmission among men who have sex with men,” they conclude.

Liver cancer risk after hepatitis C cure may be lower in people with HIV

People with HIV who were cured of hepatitis C were less likely than HIV-negative people to develop hepatocellular carcinoma (HCC – liver cancer) in the three-and-a-half years after completing hepatitis C treatment, Spanish researchers report in the journal Clinical Infectious Diseases.

The study compared the incidence of new diagnoses of HCC after direct-acting antiviral treatment had cured hepatitis C in 1035 people, 64% previously co-infected with HIV and hepatitis C. Participants were followed for a median of 3.5 years after being cured of hepatitis C. Nineteen cases of HCC were diagnosed. The risk of developing HCC was approximately 70% lower in people previously co-infected with HIV and hepatitis C.

The study investigators say it is not clear why people with HIV had a lower risk of HCC after being cured of hepatitis C. The two groups were well matched in terms of age and cirrhosis.

South Africa: delays in registering direct-acting antivirals for hepatitis C

The Daily Maverick reports that direct-acting antivirals, such as sofosbuvir and daclatasvir, remain unregistered in South Africa, forcing physicians treating hepatitis C to import the medications on a named patient basis. The delay is due to national regulatory barriers, which also make it difficult for generic manufacturers to license generic sofosbuvir and daclatasvir in South Africa.

Hepatitis testing and treatment in homeless people

ITV News reports that Liverpool University Hospital NHS Foundation Trust tested 400 homeless people in temporary accommodation during lockdown for hepatitis C since June. Over 60 have begun treatment for hepatitis C or HIV.

International Liver Congress 2021

The European Association for the Study of the Liver (EASL) has announced that the International Liver Congress 2021 will take place from 22-25 June in Amsterdam, the Netherlands.

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