International NASH Day

International NASH Day took place on 12 June. Co-ordinated by the Global Liver Institute, International NASH Day is designed to raise awareness of NASH (non-alcoholic steatohepatitis).

In a press release, the Global Liver Institute said: “NAFLD (nonalcoholic fatty liver disease) and NASH (nonalcoholic steatohepatitis) occur when fat continues to accumulate in liver cells leading to inflammation and injury to the cells. Symptoms of NASH can be difficult to recognise but can include fatigue and pain in the upper right abdomen. For this reason, people with NASH are often unaware of their liver condition until the disease progresses. NASH is the second leading cause of liver transplant in the US and is predicted to become the leading cause. However, early screening and lifestyle changes can have an impact on NASH progression and potentially reverse the disease in its earlier stages.

“Millions of people worldwide are at risk for the potentially fatal liver diseases of NAFLD and its more severe form, NASH.

“NASH is a major risk factor for many other health conditions. People living with NASH usually have one or more metabolic disorders (such as obesity, type II diabetes, and cardiovascular disease). Under-identified and untreated, NASH may result in serious outcomes including cirrhosis, liver cancer, liver transplant, or death. Now more than ever, the COVID-19 pandemic adds additional risks for those with NASH.”

“With the global prevalence of fatty liver disease at 25%, there is an urgent need to accelerate the adoption of the noninvasive technologies which are revolutionizing the field of NASH to more safely and effectively identify, stage, and determine treatment response in this growing number of patients,” stated Zobair Younossi, MD, MPH, President of Inova Medicine and Chairman of Department of Medicine, Inova Fairfax Medical Campus. “The Global Liver Institute’s International NASH Day plays a significant role in building awareness of screening, NASH education and advocacy, and taking actions that will significantly impact this global epidemic."

The Global Liver Institute will be making available videos of virtual panels on:

  • NASH and metabolic syndrome
  • Beyond the biopsy: the role of non-invasive tests in NASH
  • Paediatric NASH
  • NASH and obesity
  • NASH as a global public health challenge
  • NASH and liver cancer.

NASH is fastest-growing reason for a liver transplant in United States

Non-alcoholic steatohepatitis (NASH), the severe form of non-alcoholic fatty liver disease (NAFLD), is now the most common reason for a liver transplant in women, older patients and people receiving Medicare insurance in the United States, a review of liver transplants in 2019 has found.

NASH develops after chronic inflammation caused by fat accumulation in the liver damages liver cells and structure. Between 30 and 40% of adults in the United States have NAFLD and between 3 and 12% had NASH in studies published in 2011 and 2013.

The prevalence of NASH and NAFLD are growing in the United States due to obesity and prevalence of NASH is especially high among people with severe obesity (body mass index over 40).

Previous research by the same group found that NASH was the fastest-growing cause of hepatocellular carcinoma (HCC) in the United States between 2002 and 2016.

Researchers compared liver transplant waiting lists between 2002 and 2019 using the Scientific Registry of Transplant Recipients. A total of 168,441 people with chronic liver disease were listed for a transplant between 2002 and 2019, including 16.5% with HCC.

In 2002 the most common reasons for being placed on the transplant waiting list were severe liver disease caused by hepatitis C (37%) or alcoholic liver disease (16%). NASH was the reason for a liver transplant in only 5% of cases. In patients with HCC, NASH was even less common; only 1% of people with HCC had NASH, whereas 58% had hepatitis C.

In 2019 hepatitis C remained the leading indication for liver transplant wait listing (40%) overall but in several sub-groups NASH had become the most common reason. NASH was the leading indication in women without HCC (34%), in patients older than 54 years (36%), and in patients on Medicare (41%). In trend analysis, NASH was the most rapidly increasing indication for liver transplantation in patients without HCC (P<.001) and in patients with HCC (P<.0001).

Bacterial infection of the heart on the rise among people with hepatitis C in United States

Diagnoses of infective endocarditis, a life-threatening bacterial infection of the heart valves, have become more common over the past ten years among people with hepatitis C and people with opioid use disorder in the United States, but cases fell among people living with HIV, a large study published in the journal Clinical Infectious Diseases shows.

Infective endocarditis is caused by bacteria entering the bloodstream, often through injecting drug use. Infective endocarditis can lead to heart failure or stroke and is a common cause of death in people who inject drugs.

To investigate the prevalence of infective endocarditis, investigators from the US Centers for Disease Control and Prevention looked at commercial and Medicaid public health insurance databases to find cases of infective endocarditis between 2007 and 2017. They used the databases to produce weighted incidence estimates based on the US population for each year from 2007 to 2017.

They estimated an annual incidence of 13.1 cases per 100,000 persons in 2007 and 13.8 cases per 100,000 in 2017 in people with commercial insurance, a non-significant increase.

Cases increased in people with hepatitis C, from 172.4 per 100,000 in 2007 to 238.2 per 100,000 in 2017, an annual increase of 3.2%. Cases also increased in people with opioid use disorders, from 199.5 per 100,000 in 2007 to 357.1 per 100,000 in 2017, an annual increase of 5.7%. Cases also increased in young people aged 18-29 (6.6% per year) and in rural areas (2.7% per year).

“This increase appears to parallel the ongoing national opioid crisis,” the study authors wrote.

Harm reduction programmes that provide access to sterile injecting equipment including needles and syringes, cookers, filters and water, as well as alcohol swabs to clean the injection site and hand wash to minimise bacterial contamination can help to prevent bacterial endocarditis, the study authors say.

Harm reduction programmes that provide sterile injecting equipment also have the potential to provide treatment for minor bacterial skin infections and educate clients on prevention of bacterial infections.

Authors of another study had recently recommended that healthcare providers should offer testing for HIV and hepatitis C in cases of infective endocarditis or any bacterial skin infection, and discuss substance use disorder treatment options including opioid substitution therapy.

Cameroon study shows hepatitis C treatment is feasible, highly effective in sub-Saharan Africa

High cure rates for hepatitis C can be achieved in Cameroon but the cost of treatment remains out of reach for all but the wealthiest, findings from a demonstration study of direct-acting antiviral therapy published in Tropical Medicine & International Health show.

Over 10 million people were estimated to be living with hepatitis C in sub-Saharan Africa in 2015. Direct-acting antiviral treatment for hepatitis C remains out of reach in most African countries due to a lack of national screening and treatment programmes, lack of funding for treatment and unaffordable treatment.

A total of 158 out of 161 people completed treatment and 152 (96%) achieved a sustained virological response, including eleven people who experienced interruptions to treatment. Seventy-five per cent of study participants reported good adherence throughout their treatment course but there was no significant difference in virological outcomes according to level of adherence. Patients received either sofosbuvir and ribavirin, or sofosbuvir/ledipasvir with or without ribavirin.

The total cost of treatment including laboratory tests was 1914 euros. The average drug cost was 477 euros. Participants in this study paid 25% of the drug costs. The investigators say that the cost of treatment would have been reduced by 293 euros if they had used a pan-genotypic direct-acting antiviral combination to avoid genotyping and used blood tests alone to determine fibrosis.

The study investigators say that as well as reductions in treatment costs, decentralisation of treatment from specialist clinics will be necessary, as part of a national hepatitis strategy that rolls out hepatitis screening and treatment to non-specialist health facilities.

Hepatitis C in England: deaths decline but new infections steady since 2011

The number of people with chronic hepatitis C infection in England has fallen by 30% since 2016 due to direct-acting antiviral treatment, says Public Health England in a new report on the hepatitis C epidemic.

Around 89,000 people are living with hepatitis C in England, Public Health England estimates.

Hepatitis C-related mortality and morbidity continue to decline. The proportion of liver transplants that are carried out due to hepatitis C has halved since 2009. The proportion of people on the liver transplant waiting list due to cirrhosis caused by hepatitis C has fallen by 44% compared to pre-2015 levels.

Deaths from liver disease caused by hepatitis C (including liver cancer) fell by 20% between 2015 and 2018. Deaths among people with hepatitis C from all causes fell by 34% over the same period. England achieved the World Health Organization (WHO) target of reducing hepatitis C-related deaths by 10% three years ahead.

Public Health England says that the WHO target of reducing hepatitis C-related deaths by 65% by 2030 looks achievable in England if the number of people treated continues to rise.

World Hepatitis Day website and campaign materials launched

The World Hepatitis Alliance (WHA) has launched a brand new World Hepatitis Day website and 2020 campaign materials

World Hepatitis Day takes place each year on 28 July. As part of a global three-year WHA campaign, this year’s theme is 'Find the Missing Millions' as in the past two years.

Based on feedback from WHA's 2019 World Hepatitis Day survey and consultations with WHA members and World Hepatitis Day supporters, WHA has designed a new suite of materials to help supporters raise awareness this year.

The materials are available to download in Arabic, Chinese, English, French, Portuguese, Russian and Spanish, or can be translated into a wide range of other languages using an online customisation tool. World Hepatitis Day supporters can also use this tool to add their own messaging, background, and logo to the materials.

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