The aim of infohep.org is to develop a high-quality online resource to increase awareness of viral hepatitis, its treatment, and the needs of people living with viral hepatitis in Europe.

The European Liver Patients Association (ELPA) and NAM (aidsmap.com) are working together on infohep.org.

We work to provide access to accurate, clear information to support health professionals and advocates working in the hepatitis field across Europe.

We will be adding new features and resources to the website regularly.

Each month infohep.org will send you an email bulletin summarising the latest news and research on viral hepatitis. The bulletin contains links to news published at infohep.org so that you can find more details of news that interests you.

We will publish news reports on scientific publications and scientific conferences that are relevant to prevention and care for viral hepatitis. We will also publish news on major policy developments that affect prevention and care for viral hepatitis, especially in the European region. We will also publish news on advocacy for access to treatment and improved policy responses to viral hepatitis.

The bulletin will also keep you up to date on new developments on the infohep.org website.

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Researchers gathered in Amsterdam last month for a major conference on hepatitis and the liver.

Kris Kowdley of Virginia Mason Medical Center. Photo by Liz Highleyman/ hivandhepatitis.com.

A number of important studies were presented concerning the safety and effectiveness of new anti-hepatitis C (HCV) drugs used in combination without interferon.

The results of several studies were highly encouraging.

Current HCV therapy is based on pegylated interferon and ribavirin. These drugs don't always work and can cause unpleasant side-effects.

But results presented to the Amsterdam conference showed that an interferon-free combination of drugs that work directly against HCV can achieve a 90% cure rate. The study involved people with genotype 1 infection.

Other research showed that a two-drug combination of direct-acting drugs can achieve high rates of sustained virological response (SVR, considered a cure) in people with the easier-to-treat genotype-2 infection.

Another combination of three drugs being developed by Bristol-Myers Squibb cured over 90% of patients with genotype 1 infection after 12 weeks of treatment.

Most of these interferon-free combinations will need to be studied in larger trials before they are licensed for use. Nevertheless, it seems likely that HCV treatment consisting entirely of direct-acting agents will be a reality within a few years.

Until then, pegylated interferon will remain a mainstay of therapy.

Mark Sulkowski, Johns Hopkins University, speaking at the International Liver Congress 2013. Photo by Liz Highleyman, hivandhepatitis.com.

Research presented to the conference showed that triple-drug combinations based on investigational protease inhibitors in combination with pegylated interferon/ribavirin can achieve impressive results. An 80% SVR rate was seen in people treated with a combination incorporating the protease inhibitor faldaprevir. A similar response rate was observed in people taking simeprevir, also a protease inhibitor. Both drugs were tested in people new to treatment. Both protease inhibitors had few serious side-effects. Both will begin to become available in Europe and the United States within the next year if marketing approval is granted.

Another protease inhibitor called MK-5172 is a little further behind in the development process. This drug also showed a very high SVR rate in previously untreated people with genotype 1 infection.

Another drug, a nucleotide polymerase inhibitor called sofosbuvir, produced very high cure rates in patients with genotype 1 and 4 HCV infection when combined with pegylated interferon/ribavirin. Almost 90% of patients were cured after 12 weeks of treatment. Sofosbuvir is currently being reviewed for marketing approval in Europe and the United States.

Professor Mark Thursz, Secretary-General of EASL, said that he expected sofosbuvir or the new protease inhibitors, used in combination with pegylated interferon and ribavirin, to replace the currently available protease inhibitors quickly.

New treatments are also achieving good outcomes in people who did not respond to an earlier course of interferon-based therapy.

However, there was also evidence that triple-drug therapy based on the currently licensed protease inhibitors telaprevir (Incivo) and boceprevir (Victrelis) can involve a high risk of serious side-effects and infections. The research involved people with liver cirrhosis – the group most in need of treatment now and unable to wait for more powerful and better-tolerated drugs.

At the moment hepatitis C treatment courses containing interferon last for 48 weeks in the majority of patients. Studies of both faldeprevir and simeprevir showed that the vast majority of patients were able to stop all treatment after 24 weeks.

Sofosbuvir combined with pegylated interferon and ribavirin achieved a very high rate of cure after 12 weeks of treatment.

Shorter treatment courses containing interferon are likely to become the standard of care within the next few years, depending on the speed of drug approval and reimbursement approval. HCV genotype and IL28B genotype may influence the length of treatment that will be needed. Further research will be needed to identify the optimal duration of treatment for different groups of patients using newer drugs in combination with interferon.

Shorter treatment courses will also be the rule with newer interferon-free combinations. Once again, the length of a treatment course is likely to depend on the individual characteristics of the patient.

There are several different variants of hepatitis C. These are called genotypes. They occur at different frequencies in different parts of the world. Some HCV genotypes are described as harder to treat, especially genotype 1. Studies presented at EASL showed several trends that will be important to watch as new drugs are developed:

• Direct-acting antivirals developed to treat genotype 1 have tended to produce better results against genotype 1b than genotype 1a. But some studies found no difference. The protease inhibitor simeprevir, for example, performed just as well in genotype 1a as in genotype 1b patients.
• Genotypes 2 and 3 are considered easier to treat. Yet two studies testing sofosbuvir and daclatasvir showed that patients with genotype 2 are more likely to be cured than patients with genotype 3.

W Ray Kim speaking at the International Liver Congress 2013. Photo by Liz Highleyman, hivandhepatitis.com

Treatment for hepatitis B virus (HBV) with lamivudine reduces the risk of liver cancer by around 50% if viral suppression is maintained. Many people develop resistance to lamivudine over time. New research presented at EASL showed that people treated with tenofovir (Viread) begin to show a reduced risk of liver cancer after at least five years of treatment.

Other research looked at whether early treatment of hepatitis B with tenofovir and another drug called emtricitabine resulted in long-term suppression of HBV. The study looked at treatment of hepatitis B in patients with normal liver enzyme levels (ALT) and no signs of liver damage but with a high viral load. Current guidelines do not recommend treatment for this group of patients who are described as immune tolerant. The study found very good rates of viral suppression, especially in women, but no patient experienced the loss of hepatitis B surface antigen (HBsAg). This means that early antiviral treatment lasting around four years did not result in clearance of hepatitis B surface antigen, which is the closest thing to a cure. The researchers concluded that more study is needed to identify whether any immune-tolerant patients would benefit from early treatment.

A symposium on compassionate access to new HCV drugs was organised by the European Liver Patients Association during the conference. Patient advocates and physicians emphasised the importance of providing early access to new drugs for people in urgent need of treatment. These groups of patients include people waiting for liver transplants, people who have experienced recurrence of hepatitis C and liver damage despite a liver transplant, people with liver cirrhosis and people with HIV/HCV co-infection who are experiencing fast progression of liver disease.

The vast majority of people around the world who are infected with hepatitis B or C do not have access to current therapies because they live in countries which cannot afford to provide the drugs. Even within the European region treatment is rationed in many countries on the grounds of cost.

Médecins sans Frontiéres published a report during the conference which examined how access to treatment for hepatitis C can be widened.

A meeting organised by Treatment Action Group looked at strategies for increasing access. Key points from the meeting included:

• More information about the true extent of viral hepatitis burden is needed in order to convince governments and global policymakers to act.
• A better-trained workforce will be needed in order to expand treatment.
• The cost of treatment needs to come down: countries such as Egypt show what can be done when governments commit to a large-scale national treatment programme.
• A mechanism for World Health Organization evaluation and approval of locally produced versions of pegylated interferon and ribavirin is needed. This mechanism can ensure that good quality products can be manufactured and licensed in low- and middle-income countries. The availability of 'biosimilar' versions of pegylated interferon has the potential to drive down prices and expand access.
• Advocates need to create alliances with a wide range of groups in order to increase the pressure for treatment access.

We aim to provide a comprehensive online database of organisations offering services to people with hepatitis or working in the field of viral hepatitis. We already list 188 services in the European and Eastern Mediterranean region. You can also search for services by country.

Check the infohep database of services and organisations working in viral hepatitis to find out whether your organisation is already listed.

If we don’t have a listing yet, please add your details for review and inclusion in the database.