Hepatology conference in London hopeful about treating and eradicating hepatitis

Hepatology conference in London hopeful about treating and eradicating hepatitis
Alcoholic hepatitis in liver as shown with a microscope, credit: Wikimedia Commons

New breakthroughs in the treatment of Hepatitis D and reducing liver fat featured prominently in the programme of the International Liver Congress 2022 held last week in London.

The congress is convened annually by the European Association for the Study of the Liver (EASL). This year's edition attracted onsite thousands of researchers, doctors, policy makers, industry leaders and journalists from across the globe. The event took place against the backdrop of a global increase in the prevalence of liver diseases.

Since its foundation in 1966, EASL has grown to over 4,800 members from all over the world, including many of the leading hepatologists in Europe and beyond.

Liver disease is now the biggest killer of 35–49-year-olds in the UK. In Europe, chronic liver disease has a substantial impact on young and middle-aged individuals in their prime working years, with the peak age of death occurring in the late 40s and early 50s.

Chronic hepatitis C infection accounts for 58 million cases globally and 400,000 deaths each year. Data from the World Health Organization (WHO) shows that liver disease is now second only to ischemic heart disease as the leading cause of years of working life lost in Europe. On average, two thirds of all potential years of life lost due to mortality from liver diseases are years of working life.

As a consequence of rising levels of obesity, Non-Alcoholic Fatty Liver Disease (NAFLD) has become the most common cause of liver disease in Western countries, affecting one in four people and the fastest-growing disease in the world. In a proportion of people, NAFLD can cause progressive liver damage, and in some of cases it may even lead to the development of liver cirrhosis and liver cancer.

It is estimated that if left unchecked, the annual predicted cost of NAFLD in Europe is estimated to be greater than €35 billion in direct costs to the health system, and a further €200 billion by way of wider costs to society.

New medicines

A stand-alone cure for Hepatitis D has so far eluded scientists. Found in two to three per cent of people living with Hepatitis B, Chronic Hepatitis Delta, as it also known, is the most acute of the hepatitis family and extremely hard to treat.

But treatment seems to be on its way. Results presented at the conference from a Phase III trial have confirmed that the drug Bulevirtide can successfully treat and cure Hepatitis D, according to EASL.

“We may well be entering into a new golden age of hepatology science,” said Thomas Berg, Secretary-General of EASL and Head of the Division of Hepatology at Leipzig University Medical Center in Germany. “There is respite coming for those people living with Hepatitis D and we are making progress towards finding a cure for Hepatitis B which affects millions of people around the world.

As regards NAFLD, treatment is also on its way. A first in-human trial of the drug Pemvidutide has shown that it is effective at reducing a person`s weight. What sets its aside from weight loss drugs is that it simultaneously reduces liver fat which in excess levels can be life threatening.

In a separate randomised trial comparing two types of weight reducing diets, researchers have concluded that a low carbohydrate high fat diet is much more effective at reducing liver fat in people living with type 2 diabetes than a high carbohydrate low fat diet.

“The global burden of NAFLD is so high that we´re going to need all the prevention and treatment tools at our disposal to make any real inroads over the coming years,” said Professor Aleksander Krag, Vice Secretary-General of EASL and a senior consultant of Hepatology in Denmark.

“Prevention through diet is a no-brainer policy (requires a minimum of thought): it´s something most people can do of their own accord, and it costs governments very little. For the sake of our younger generations, we have to take the issue of good diet seriously. Banning advertising of junk food, for instance, would be a good start.”

New guidelines

”Hepatitis is one of the most devastating diseases on earth, but it’s also one of the most preventable and treatable, with services that can be delivered easily and cheaply at primary health care level,” said Dr Meg Doherty, Director of WHO Global HIV, Hepatitis and STI Programmes, at the conference.

WHO presented updated guidelines on hepatitis C infection with the potential to substantially scale up access to testing and treatment in low- and middle-income countries. Their implementation is expected to contribute to global efforts to eliminate the disease.

The guidelines include three key recommendations: Simplified service delivery, with a shift to delivering testing and treatment in primary care and to care delivered by general practitioners and nurses, rather than specialists; New diagnostic recommendations to make testing more efficient; and, for the first time, the same recommended treatment for adults for use in adolescents and children down to the age of 3 years.

According to WHO, since the revolutionary short course curative treatment became available in 2014, more than 10 million have been treated and cured globally, and WHO has an ambitious plan for global elimination. But there is still a large testing and treatment gap, and less than 21% of those infected have been diagnosed and 13% treated.

What are the data about the cases of acute hepatitis in children occurring in Europe and beyond?

As of 20 June 2022, 33 countries in all five WHO regions have reported 894 probable cases of severe acute hepatitis of unknown aetiology, WHO told The Brussels Times. Over half (52%) of probable reported cases are from the WHO European Region (20 countries reporting 449 cases), including 262 cases (30% of global cases) from the UK alone.

Of the probable cases, at least 41 children have required transplants (5%), and 18 deaths (2%) have been reported to WHO. Around 30% have required intensive care support, based on data from Europe. The majority of cases (75%) based on data from Europe are below 5 years.

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