Graph from the infographic published alongside the report.

In a report issued on 3 December, the EASL-Lancet Liver Commission said a paradigm shift is needed in the liver response in Europe to tackle the second-biggest cause of years of working life lost in Europe.

The medical profession needs to change its approach to liver disease: instead of focusing on the management of end-stage complications, it needs to shift towards prevention, proactive case-finding, with early identification of progressive liver fibrosis, early diagnosis and early treatment, the EASL-Lancet Liver Commission said in a press statement.

As well as emphasising the importance of screening for liver disease, prevention and early treatment of viral hepatitis, the report also recommends the adoption of consistent public health policies across Europe designed to reduce the consumption of alcohol, high-fat and high-sugar foods, to combat alcoholic and non-alcoholic fatty liver disease.

Key recommendations of the EASL-Lancet Liver Commission:

• Implementation of standardised and simplified liver blood tests for earlier detection and prompt care.
• Utilisation of opportunities created by the hepatitis B and C drugs as well as hepatitis B and A vaccines to achieve viral hepatitis elimination in Europe.
• Increase awareness and provide financial incentives for primary care peers and professionals.
• Non-viral liver diseases must be classified along with other non-communicable diseases to engage appropriate care models.
• All forms and sources of stigma towards people at risk of or with liver disease must be opposed – relevant changes to the medical nomenclature should come first.
• Public disclosure of prices for antiviral drugs throughout Europe would reinforce the WHO/World Health Assembly resolution to improve fairness of market prices.
• European governments must introduce uniform policies to reduce the harmful use of alcohol.
• A complete social and digital media ban on the marketing of alcohol and ultra-processed, high-fat and high-sugar foods targeted to children.
• Promote industry-led food reformulation and minimisation of social inequities by subsidising healthy foods.
• EU and European governments should prioritise the harmonisation of critical forms of public health interventions and health-related policies across Europe.

Advanced liver fibrosis in people with non-alcoholic fatty liver disease was associated with an increased risk of liver-related complications, a prospective study in the United States has found.

Fat accumulation in the liver, or non-alcoholic fatty liver disease (NAFLD), affects up to a quarter of the population globally. Fat accumulation may lead to inflammation – non-alcoholic steatohepatitis (NASH) – and scarring of the liver (fibrosis). As fibrosis becomes more extensive, normal liver function declines, eventually leading to liver failure, or decompensation.

To understand the relationship between liver damage, liver complications and other serious health outcomes, the NASH Clinical Research Network in the United States studied a cohort of people with NAFLD who they followed for at least 48 weeks.

The cohort consisted of 1773 adults who had biopsy-confirmed NAFLD and at least 48 weeks of follow-up.

Mortality was associated with fibrosis stage at baseline. People with F4 fibrosis were almost four times more likely to die during follow-up compared to people with F0-F2 fibrosis. Liver-related mortality and liver decompensation were also more frequent in people with F4 fibrosis, who were over 12 times more likely to die of a liver-related cause during follow-up compared to people with F0-F2 fibrosis.

The study investigators say that their findings are important for studies of agents designed to treat NASH and that these should be evaluated according to their efficacy in preventing progression to liver cirrhosis.

But in short-term studies, NASH resolution or a 2-point reduction in the NAFLD activity score may be appropriate markers for clinical trials of NASH treatments.

Olya Maximenko/Shutterstock.com

People who have experienced failure of multiple courses of direct-acting antiviral treatment can be cured of hepatitis C with a combination of three direct-acting antivirals plus ribavirin, a review of heavily treatment-experienced patients in the United States shows.

The review, presented last month at The Liver Meeting, found that even a patient who had undergone five unsuccessful courses of treatment was cured. None of the 12 patients treated with the regimen experienced treatment failure. The findings offer hope that eventually, everyone can be cured of hepatitis C, even if they do not respond to recommended first- and second-line regimens.

The retrospective study of patients receiving hepatitis C treatment in the Kaiser Permanente Northern California healthcare system and at University of California San Francisco identified 12 people who received sofosbuvir, glecaprevir and pibrentasvir, and ribavirin.

Each of the 12 patients achieved a sustained virologic response 12 weeks after completing treatment. Seven were treated for 16 weeks and five for 24 weeks.

Domizia Salusest | www.domiziasalusest.com

Access to direct-acting antivirals to cure hepatitis C has slashed incidence rates for groups most affected in Australia, an analysis by researchers at Monash University, Melbourne, shows.

Among gay and bisexual men living with HIV, incidence fell by 78% in 2019 when compared to 2015, the year before direct-acting antiviral treatment became widely available. A similar trend in hepatitis C infections was seen for HIV-negative men taking PrEP, with an 80% decline in 2019 compared to 2016.

A total of 6744 men with HIV were included in the incidence analysis, comprising 33,150 person-years of follow-up with 290 new hepatitis C infections for the period. This produced an overall incidence of 1.03 per 100 person-years, with the highest incidence in 2010 (2.12 per 100 person-years) and the lowest in 2019 (0.22 per 100 person-years).

Among all 20,590 HIV-negative men included in the analysis between 2009 to 2019, overall incidence was 0.20 per 100 person-years. During 60,512 person-years of follow-up, there were 122 new infections. Incidence fluctuated between 0.49 per 100 person-years in 2009 to 0.07 per 100 person-years in 2019. However, unlike the trend with gay and bisexual men with HIV, there was no change in incidence in 2016, 2017, or 2018 compared to 2015.

“These findings suggest that universal, unrestricted hepatitis C treatment among gay and bisexual men with HIV may also have a treatment-as-prevention benefit for gay and bisexual men more broadly,” the authors conclude. “Hepatitis C incidence among gay and bisexual living with HIV has declined significantly in Australia following the introduction of directly acting antiviral treatment.

Providing hepatitis B treatment for everyone who needs it in Malawi is an achievable public health goal, researchers from the Malawi-Liverpool-Wellcome Trust programme report, following community surveys in Blantyre, Malawi.

Hepatitis B treatment provision would be far less ambitious than the scale of programme required to deliver antiretroviral treatment for people with HIV in Malawi. Approximately 25,000 people in Malawi need treatment for hepatitis B, the research group estimates, based on assessments of disease status in people tested in household surveys between 2016 and 2018.

The survey also demonstrated the enormous impact of the country’s infant hepatitis B vaccination programme, which began in 2002. Comparing the prevalence of hepatitis B surface antigen in people born before and after 2002, the researchers estimate that vaccination has reduced the prevalence of chronic hepatitis B infection by up to 96%. The findings provide the first assessment of community hepatitis B vaccine impact in southern Africa.

The household survey tested 6073 people from a population of 97,386 people. Hepatitis B surface antigen prevalence standardised for age and sex was 3.1%. Using World Health Organization, EASL and AASLD criteria for treatment, 2.9%, 5.7% and 8.7% of people without HIV who tested HBsAg positive were eligible for treatment, respectively. All but one person with HIV who tested HBsAg positive was already receiving antiretroviral treatment containing drugs active against hepatitis B virus.

Projecting the proportion eligible for treatment by EASL criteria to the entire population of Malawi (17.6 million), the researchers estimate that 25,586 people in Malawi need hepatitis B treatment.

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