Hepatitis Awareness Month: 10 recent reports on viral hepatitis

The Centers for Disease Control and Prevention have designated May as Hepatitis Awareness Month to raise public awareness of viral hepatitis including the most common strains: hepatitis A, hepatitis B and hepatitis C. Additionally, the CDC designated May 19th as Hepatitis Testing Day.

The following recent reports, many from recent meetings including the International Liver Congress 2018, include new research data on hepatitis prevalence and outbreaks, transmission risks and treatment outcomes.

Alcohol, cannabis use have no impact on HCV cure rates

Although sustained virologic response maintained a high level no matter the alcohol or cannabis consumption in a German registry, those who reported drinking alcohol in excess were more likely to be lost to follow-up, according to a presentation at the International Liver Congress 2018.

“Alcohol or cannabis consumption did not diminish cure rates,” Stefan Christensen, MD, from Center for Interdisciplinary Medicine, Munster, Germany, said during his presentation. “However, loss to follow-up is more likely in patients with current or former drug use compared to patients without any drug history and in patients with a high alcohol consumption.” Read more

Italian hepatitis A outbreak among MSM linked to two European strains

New data linked hepatitis A cases from an ongoing outbreak among men who have sex with men in the Lombardy region of Italy to strains found in two other recent European outbreaks, according to a presentation at the International Liver Congress 2018.

“We wanted to understand the ongoing HAV outbreak within a large group of patients including MSM from seven hospitals in the Lombardy region,” Massimo Iavarone, MD, from the Fondazione IRCCS Cà Granda Ospedale Maggiore Hospital in Milan, Italy, said in a press release. “We used viral phylogenetic analysis to see if this outbreak was linked to other recent European outbreaks.” Read more

Mother-to-child HBV transmission risk increases with maternal viral load

A systematic review and meta-analysis revealed that maternal viral load among mothers with hepatitis B was a significant risk factor for mother-to-child transmission and was dose-dependent with HBV transmission incidence.

“Hepatitis B virus (HBV) infection is a major global health problem. According to WHO estimates, 240 million people are chronically infected with hepatitis B,” Hong-Lin Chen, MD, from the Nantong University, China, and colleagues wrote. “HBV infection acquired via mother-to-child transmission (MTCT) is typically considered to be one of the major causes of chronic infection.” Read more

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Injection drug use harm reduction decreases HCV prevalence

Model projections of scaled-up opioid substitution therapy and needle and syringe programs in Europe demonstrated a potential reduction in hepatitis C prevalence of 18% to 79% and could reduce treatment scale-up need by 20% to 80%.

“Preventing HCV transmission among people who inject drugs (PWID) is critical for averting future liver disease in Europe and elsewhere and new HCV infections in this group,” Hannah Fraser, PhD, from the University of Bristol, United Kingdom, and colleagues wrote. “Primary prevention through opioid substitution therapy (OST) and high-coverage needle and syringe programs (NSPs) can reduce HCV transmission among PWID and averts new HCV infections, but substantial reductions in HCV prevalence are unlikely to be achieved without scaling-up HCV treatment.” Read more

HBV surface protein ratios predict inactive carrier phase

Lower ratios of hepatitis B middle surface proteins and large surface proteins predicted the inactive HBV carrier phase better than total HBV surface antigen, according to recently published data.

“Differentiating between patients being in a stable inactive ‘carrier’ state as compared with those with disease activity or risk of disease reactivation (the [inactive carrier] and active phases of HBV infections) is of paramount importance in clinical practice,” Maria Pfefferkorn, MD, from the University Hospital Leipzig, Germany, and colleagues wrote. Read more

Myrcludex B with tenofovir shows response in HDV/HBV coinfection

Adding myrcludex B to existing tenofovir treatment in patients with hepatitis delta and hepatitis B coinfection led to virologic response and biochemical improvement, according to a presentation at the International Liver Congress 2018.

“We have learned in recent years that HDV RNA reduction or suppression even in the presence of HBS antigen is associated with an improved clinical long-term outcome,” Heiner Wedemeyer, MD, chairman of the department of gastroenterology and hepatology at the University Clinic Essen, said during his presentation. “Blocking HBV/HDV entry with myrcludex B (MYR Pharma) is a safe and promising strategy to treat chronic hepatitis delta. The optimal treatment durations and possible combination therapies need to be determined and ... cries for longer therapy. We performed modeling studies suggesting 2 to 3 years should be sufficient to reduce HDV RNA levels to undetectable.” Read more

One-third of chronic hepatitis E cases transmitted through blood products

Blood products were linked to 36% of chronic hepatitis E cases among a group of immunosuppressed patients, according to a study presented at the International Liver Congress 2018.

“We are propagating screening of blood donations because an infected blood product given to an immunocompromised patient has serious consequences,” Ansgar Lohse, MD, from the University of Medical Center Hamburg-Eppendorf, Germany, told Healio Gastroenterology and Liver Disease. “Just testing blood products given to immunocompromised patients is almost impossible because you don't know ahead which product will go to which patients.” Read more

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Hepatitis B increases mortality risk in patients with acute hepatitis E

Chronic hepatitis B virus infection is an independent risk factor for liver-related mortality in people with acute hepatitis E virus infection, according to researchers. Hepatitis E (HEV) is also associated with a higher mortality rate than acute hepatitis A (HAV), they wrote in Clinical Infectious Diseases.

“Chronic hepatitis B virus [HBV] infection is an important risk factor of liver-related mortality in patients with acute [HEV], who had poorer clinical outcomes compared to those with acute [HAV],” researcher Jimmy Che-To Lai, MD, a professor in the Chinese University of Hong Kong department of medicine and therapeutics, and colleagues wrote. “Further studies on the benefits of [HEV] vaccine in high-risk patients with pre-existing chronic [HBV], particularly those with other important risk factors such as coexisting renal failure, would be warranted.” Read more

SVR after HCV therapy reduces extrahepatic mortality, manifestations

Results of a recent systematic review and meta-analysis showed that sustained virologic response after hepatitis C therapy can reduce extrahepatic manifestations including insulin resistance and cardiovascular risks.

“Extrahepatic manifestations in HCV-infected patients are either rare but very severe on the short term ... or very frequent with a potential severity on the mid-long term,” Patrice Cacoub, MD, from the Hôpital La Pitié-Salpêtrière, France, and colleagues wrote. “In most cases, they are independent of the severity of the liver disease. Antiviral therapy can reduce hepatic manifestations of HCV and also many extrahepatic manifestations related to HCV when SVR is achieved.” Read more

EASL releases clinical practice guideline for hepatitis E

The European Association for the Study of the Liver released a new clinical practice guideline for hepatitis E, specifically focused on genotype 3 and 4, which EASL recently published in Journal of Hepatology.

“Infection with hepatitis E virus (HEV) is a significant cause of morbidity and mortality, representing an important global health problem,” Harry R. Dalton, MD, from the University of Exeter, United Kingdom, and colleagues wrote. “Our understanding of HEV has changed completely over the past decade. Previously, HEV was thought to be limited to certain developing countries. We now know that HEV is endemic in most high-income countries and is largely a zoonotic infection.” Read more