Looking past HCV: Top viral hepatitis reports from 2018

The safety and efficacy of direct-acting antivirals for hepatitis C have begun to move HCV from the forefront of chronic liver disease into the realm of potential elimination. Many researchers are now focusing on the next task: improved care and possible cure of other viral hepatitis infections.

Healio Gastroenterology and Liver Disease presents the following reports from 2018 focused on recent hepatitis A outbreaks and the need for increased vaccination, hepatitis B trends and outcomes, results of phase 2 Lambda trial for treating hepatitis D, and EASL’s recent guideline for hepatitis E.

HBV rates rising in women from same U.S. regions with drug-related HCV

U.S. states in the Appalachian region demonstrated increased rates of hepatitis B among women despite overall national rates of acute and chronic HBV remaining stable or declining among women and children, according to data presented at The Liver Meeting 2018.

“Hepatitis C prevalence among women of childbearing age has increased over the last year due to the injection drug use epidemic,” Tatyana Kushner, MD, from the Icahn School of Medicine at Mount Sinai in New York, said in her presentation. “This increase has been most pronounced in women and infants — implying mother-to-child transmission — especially across the central Appalachian region in the United States. However, national rates of hepatitis B have not been examined in this group of women of childbearing age and children recently.” Read more

Patients achieve HDV RNA decline, negativity in Lambda phase 2 study

Results from a phase 2 study of Lambda for the treatment of hepatitis D showed a decline of HDV RNA in more than half of treated patients, according to a press release from Eiger BioPharmaceuticals.

“Lambda interferon demonstrated better tolerability in HDV-infected patients who were previously treated with alpha-interferon,” study co-lead investigators Ohad Etzion, MD, from Soroka University Medical Center, and Saeed Hamid, MD, from Aga Khan University, said in the release. “Fewer episodes of cytopenia, flu-like symptoms, and psychiatric events in this study make Lambda interferon particularly attractive for further development as a monotherapy or in combination with other treatments for HDV.” Read more

Hepatitis A outbreaks in 2017 linked to drug use, homelessness

Significant incidents of hepatitis A outbreaks occurred through direct person-to-person transmission among drug users and homeless individuals during 2017, according to a report from the CDC.

“Outbreaks with direct HAV transmission among persons reporting drug use or homelessness signals a shift in HAV infection epidemiology in the United States, and vaccination of these populations at high risk can prevent future outbreaks,” Monique Foster, MD, from the division of Viral Hepatitis at the CDC, and colleagues wrote in the report. Read more

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Global coverage of HBV treatment remains low despite declining costs

The international market price of generic tenofovir, prequalified by WHO for hepatitis B virus infection, declined more than 85% from 2004 to 2016, according to recent MMWR data. Still, only one in six patients diagnosed with HBV infection worldwide received treatment in 2016.

Yvan Hutin , MD, PhD, medical epidemiologist from WHO’s department of HIV and the Global Hepatitis Program, and colleagues found that treatment coverage was low in low- and middle-income countries (LMICs), even though most these countries could legally procure generic versions of both WHO-recommended HBV medications, entecavir and tenofovir. Read more

Patients with HBV, HCV should receive hepatitis A vaccination

Physicians should consider administering hepatitis A vaccines to their patients with hepatitis B and those with hepatitis C, according to a commentary published in Gastroenterology.

“Recent large outbreaks of HAV related to foodborne and person-to-person exposures have resulted in substantial rates of morbidity and mortality; these events underscored the relatively low prevalence of immunity against HAV infection among the U.S.-born adult population,” Anne C. Moorman, MPH, from the CDC, and colleagues wrote. 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

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

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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

Novel score predicts liver cancer risk during HBV antiviral therapy

Researchers developed a predictive risk score for the development of hepatocellular carcinoma during oral antiviral therapy in patients with chronic hepatitis B, according to recently published data.

“The score requires simple information that is readily available in all treated patients,” Yao-Chun Hsu, MD, from the Fu-Jen Catholic University, Taiwan, and colleagues wrote. “By stratifying patients at different risks of HCC, the easily applicable score may inform the clinical practice and health care policy in the era of antiviral treatment for [chronic HBV].” 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