3^rd World Congress on Hepatitis and Liver Diseases October 10-12, 2016 Dubai, UAE

Biography:

Hakim Bouchkira is a Nurse Coordinator of Mobile Hepatitis Team at Centre Hospitalier de Perpignan, France. He is working in Perpignan Hospital since 2006.

Abstract:

Introduction: Hepatitis C was most frequent in vulnerable people who were insecure and had multiple viral risk factors. Vulnerable people included inmates, migrants, drug users, homeless and psychiatric patients. Accessibility of health system was not so easy, most part for these populations because of social, psychiatric and addictive issues. In May 2014, French national experts rapport reported about connections between social vulnerability and hepatitis B and C incidence. That is was why vulnerable populations were particularly affected by HCV and HBV infections. Validated tools to evaluate this phenomenon were not sufficiently put to use social inequalities of healthcare must be taken in account in fight against HBV and HCV. This report recommended evaluating first social vulnerability situation, proposing best support and taking in account these factors with medical and social workers. Hepatitis Mobile Team (HMT) was created in July 2013 to increase screening care and treatment of hepatitis B and C patients. We proposed 15 services: Screening by Dried Blood Spot (DBS) HIV HBV HCV, Mobile Fibroscan* in different sites, social screening and diagnosis (EPICES score), outreach center with specific health care workers 5 days, free blood tests in primary care if no social insurance, advanced on-site specialist consultation, access to obligatory pre-treatment commissions, individual psycho-educative sessions, collective educative workshops, staff training, drug users prevention, peer to peer program, low cost specific patients mobile phones, specific one day hospitalizations before and after antiviral treatment and Green thread: outside DBS and FIBROSCAN* in specific converted truck.

Objective: Evaluation of modification of specific social score before and after direct antiviral agent HCV treatment in vulnerable people.

Methodology: We used specific social score called EPICES (evaluation of individuals’ factors affecting vulnerability in health exams centers) two times for every patient, in first contact and 3 months after treatment. EPICES score (14 questions) was created in 2004 and was demonstrated specific action to detect and quantify precarious people. EPICES score was positive for precarious situation at 48.5 value and maximum score was 100. All patients with value above 48 saw social worker for social evaluation.

Preliminary Results: HMT used EPICES score since September 2014 for all new HCV patients. In 2015, 36 EPICES scores were realized before AAD treatment with average value at 77. In 2016, 64 scores EPICES were realized before DAA treatment with average score at 70 and average post treatment value at 52. Difference between pre and post treatment values were significant (p<0.05).

Conclusion: Hepatitis Mobile Team was an innovative concept that promotes return of known HCV patients and new diagnosis patients in circuit of care by facilitating access to screening and FIBROSCAN* but also for social worker and hepatologist consultation. Training and coaching people with precarious situation, investment and adherence to project of our partners, increase number HCV patients supported treated and cured.

Biography:

Arnolfo Petruzziello is the Head of the Diagnostic Virology and Molecular Biology Unit of National Cancer Research IRCCS Italia Fondazione G. Pascale in Naples. He has done Post-graduation in Microbiology and Virology and PhD in Molecular and Cellular Pathology. He is an Editorial Board Member and peer-reviewer for: World Journal of Gastroenterology and Archives of Microbiology and Biotechnology.

Abstract:

Background: Hepatocellular carcinoma (HCC) is the third most common cause for cancer death in the world, especially in patients with chronic hepatitis C virus (HCV) infection. The rate of progression from chronic hepatitis to HCC is variable and several factors have been identified as important predictors of progression, some related to the host (older age, longer duration of infection, male sex or alcohol consumption >50 g/day), others to the environment (Hepatitis B virus or HCV infection). Despite several studies suggesting an association between HCV genotype 1b and risk of HCC, no consenus has emerged yet on this matter, which is still controversial. The purpose of this study was to clarify whether the genotype 1b is associated with a higher risk of HCC than other genotypes.

Material & Methods: A total of 121 consecutive cases of HCC, fulfilling the diagnostic criteria from the Barcelona 2000 EASL conference, and 125 patients with other malignant tumors as control, enrolled between February 2013 and November 2015, were included in the study. Serum of each HCC or control patient was evaluated for serological evidence of HCV infection (Vitros Ortho Clinical Diagnostics), viral load estimation by Taqman Real time PCR system (Roche Diagnostic) and genotyping by HCV LiPA test (Siemens) .

Results: About eighty per cent (80.8%) of HCC patients had positive anti-HCV which was significantly greater than the control group (34.4%, p=0.01). Anti-HCV positive patients have a risk of progression to HCC almost 8 times than the control group (OR= 8.04). The male/female ratio for the HCC cases was 3.06:1. Males with HCC significantly showed to have about 4 times risk of exposure to HCV infection (OR=3.9). Majority of HCC patients were >70 years (71.0% vs. 58.0% in the control group) and over eighty per cent of them had underlying cirrhosis at presentation (84.0%). HCV RNA seropositive rate was significantly higher (71.2%) among HCC patients if compared to the control group (44.2%, p=0.01). No difference in levels of viral load was found between HCC patients and the control group. The most prevalent genotype in HCC patients was 1b (59.4% vs. 26.4% in the control group, p=0.05), whereas the most predominant genotype in the control group was 2a/2c (63.2% vs. 21.7% in HCC patients, p=0.01). Moreover, the genotype 3a, completely absent in the control group, is the third most common genotype in the HCC patients (5.9%).

Conclusion: HCV genotype 1b is associated with a statistically higher risk of developing HCC compared to other genotypes. Patients with cirrhosis that are infected with this genotype require more intensive surveillance for the early detection and aggressive management of neoplasia

Biography:

Fatma Abdelaziz Amer has worked as the Head of Medical Microbiology and Immunology and is currently a Supervisor of the Infection Control Program, Zagazig Faculty of Medicine, Egypt. She has obtained her MSc degree in Infection Control and is the President of the Arab Alliance for the Prudent use of Antimicrobials and the Hepatitis Working Group, International Society for Chemotherapy. She has published more than 35 papers in national and international journals. She has developed two parts of infection control books. She has attended more than 50 conferences all over the world and has been aiding as a Reviewer, Editorial Board Member and Co-Editor in many national and international journals.

Abstract:

Nearly, 170 million people worldwide are suffering from chronic HCV infection. The introduction of the direct acting antivirals (DAAs) for the treatment has revolutionized the management of this major health problem. In addition to the currently available DAAs agents, recent drugs in the anti-HCV pipeline have enhanced capacity, as well as improved tolerance and safety profiles. High rates of sustained virologic response (SVR) are produced by DAAs in clinical trials (90%- 95%); nevertheless, treatment failure in real-life cohorts sometimes occurs. Treatment failure may present with null- response, breakthrough, partial response or relapse. In a given host, HCV population is a heterogeneous mixture of closely related genomes composed of the wild type plus other strains present at lower frequencies (HCV quasipecies). Under selective pressure of exposure to DAAs certain genetic variants which are normally present before start of treatment, can proliferate and become the dominant variant leading to treatment failure. These resistance associated mutations depend on the class of DAAs used and also vary between HCV genotypes and subtypes.

Breakthrough mutations have already been reported for NS3/4A protease inhibitors (O80K, V36AM, T54A/S, R1556K/T, A156S/T, D168N), for NS5A inhibitors (M28, Q30, L31V, Y93H), and for NS5B inhibitors (S282T, V321l, L159F). Emerging mutants can be detected by genotypic assays; population sequencing, clonal analysis and ultradeep sequencing. Phenotypic assays can also be used for the determination of drug susceptibility and cross-resistance profile / replicon system.

All efforts should be directed towards optimizing anti-HCV regimens to maximize SVR and minimize resistance.

Biography:

Andrew Vaillant is the inventor of Replicor’s NAP technology and has more than 15 years of experience in viral biology, antiviral drug development and nucleic acid chemistry. He has authored numerous publications and patents on the development and use of NAPs as agents to treat infectious diseases. He previously held positions at two Montreal-area biotechnology companies. He was a Postdoctoral Fellow at the Montreal Neurological Institute and holds a PhD in Cell Biology from the University of Ottawa, Canada.

Abstract:

Nucleic acid polymers (NAPs) have the unique ability to block the release of the hepatitis B surface antigen (HBsAg) from infected hepatocytes and clear HBsAg from the blood of human patients, a critical step in achieving a functional cure in HBV and HBV/HDV infection. Recent data will be presented from the ongoing REP 301 clincal trial (NCT02233075) which is assessing the safety and efficacy of the NAP REP 2139 when used in combination with pegylated interferon alpha 2a in patients with chronic HBV/HDV co-infection. These clinical data demonstrate the unique ability of NAPs to clear circulating HBsAg and HDV in patients. Clearance of HBsAg is accompanied by important immunological impacts: The appearance of anti-HBs, a synergistic improvement in the effiacy of pegylated interferon and the ability to achieve complete control of HBV and HDV infection with a finite course of treatment.

Biography:

Ligita Jancoriene was graduated from Vilnius University Medical Faculty in 1989 and completed her Residency in Gastroenterology (1993). During her PhD studies she received Clinical Training in Infectious Diseases at Karolinska Institutet, Huddinge University Hospital, Sweden (1999-2003) and defended PhD thesis in a field of Infectious Diseases and Hepatology on the Management of Chronic Viral Hepatitis C (2003). She is working at the Department of Infectious diseases of Vilnius University since 1997 and also working as a Specialist of Infectious diseases and Gastroenterology at the Centre of Infectious diseases in the Vilnius University Hospital Santarisiu Klinikos since 1996. Currently, she is a Professor at the Department of Infectious, Chest diseases, Dermatovenerology and Allergology of Vilnius University and Head of the Department for Consultation and Immunoprophylaxis at the Centre of Infectious diseases in the Vilnius University Hospital Santariškių Klinikos. She is a Member of the European Association of the Study of the Liver and International Society of Travel Medicine. She is a Board Member of the Lithuanian Society of Infectious Diseases and Baltic Immunoprophylaxis Association. She is a co-author of scientific papers in peer-reviewed journals on vaccination and treatment of chronic viral hepatitis C. She was a Principal Investigator in more than 20 clinical trials on viral hepatitis and influenza treatment and vaccination.

Abstract:

The aim of multicenter, international, real-life study was to evaluate efficacy and safety of Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir±Ribavirin in treatment-naive and treatment-experienced GT1-infected patients, who failed previous PEG-INF/RBV±first generation protease inhibitor therapy. 114 (54 males) GT1-infected (102-GT1b) patients, aged 54.4±10.6 years, were included. 28.1% were treatment-naive, 71.9% treatment-experienced. 21 patients failed previous triple therapy with telaprevir or boceprevir. 57% were cirrhotics. Treatment was scheduled for 12 weeks in 112, 24 weeks in 2 patients. RBV was administered to 89 patients. Sustained virologic response (SVR12) was assessed by HCV-RNA undetectability 12 weeks after the end of treatment (EOT). 111 patients completed therapy and had undetectable HCV-RNA at the EOT. 73 patients with available follow-up evaluation achieved SVR12. The average reduction in alpha-fetoprotein (16.3 versus 4.9, p<0.001) and hepatic fibrosis (17.3 versus 15.5, p<0.001) was demonstrated at the end of follow-up. RBV was reduced in 18, discontinued in 11 patients. The most frequent adverse events were asthenia (25.4%), fatigue (15.8%), itching (13.2%) and dyspepsia (11.4%). Treatment was disontinued in 3 patients due to exacerbation of psoriasis (day 3), depression (week 5) and elevation of ALT, AST (week 9). 10 liver transplant patients recieved 24 weeks treatment(4 males, 50.7±8.0 years, 9-GT1b, 8-treatment-experienced). RBV was administred to 9, reduced in 3, discontinued in 2 patients. All patients completed therapy and had undetectable HCV-RNR at the EOT. 9 patients with available follow-up evaluation achieved SVR12. In conclusion, treatment with Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir±Ribavirin achieved 100% SVR12. Adverse events were mostly mild and related to RBV administration.

Biography:

Asad Izziddin Dajani has obtained his Medical degree Cum Laude from Cairo University. He pursued his Postgraduate studies in Internal Medicine in UK and Austria. He has 32 years’ experience at hospitals in Egypt, Kuwait, Austria and UAE, gaining wide experience in his field. In 1984, he relocated to UAE, where he was instrumental in establishing endoscopy service at Kuwait and Al Qassimi Hospitals in Sharjah. He regularly attends and participates in local, regional and international conferences. He is regularly invited as a guest lecturer to medical conventions, institutes and pharmaceutical events. He has many publications to his credit in reputed local and international journals.

Abstract:

Nonalcoholic fatty liver disease (NAFLD) is the commonest liver disease; its prevalence had increased over the past 10 years. The treatment of NAFLD is of prime concern due to the mortality and morbidity it implies and that standard of care medications remain experimental. Treatment is focused on lifestyle modification and managing the comorbid diseases with a possible role for hepatic protective agents. Weight reduction by dietary control, physical exercise, orlistat or surgery is a pivotal step in treating NAFLD. Insulin sensitizers: Metformin and pioglitazone were used alone or in combinations with other remedies to treat NAFLD. Pioglitazone induced a convincing effect; however relapse was common which raised concern about complications. DPP-IV inhibitors and GLP-1 agonists reduced Hepatocyte Steatosis and improved hepatocyte survival. Reduction of blood lipids: Statins and Ezetimibe have good effect when used for NASH with dyslipidemia. Antioxidants: Vitamin-E, alone and with vitamin-C, EPL, sylimarin and metformin revealed limited effects. A metanalysis demonstrated that high dose vitamin-E increased all cause mortality. Pentoxiphylline targeting fibrosis showed antioxidant and antifibrotic effects. UDCA had inconsistent results and was not recommended for the treatment of NAFLD/NASH. Probiotics research had shown encouraging results and indicated that they could be an emerging therapeutic option. Investigational medicines like obeticholic acid, ARBs, elafibranor (GFT 505), and simtuzumab are being evaluated; some of them seem to be promising. Medicines in pipeline preclinical studies revealed good results with DUR-928, GR-MD-02, Aramchol, RG-125 and Cenicriviroc. A decade of clinical trials did not reveal an intervention that improved all outcomes for NASH but research indicates promising prospects.

Biography:

Prapan Jutavijittum has obtained Board of General Pathology (Anatomic and Clinical Pathology) certificate in Thailand in 1990. He is currently an Assocate Professor at Department of Pathology, Faculty of Medicine, Chiang Mai University, Thailand. He has published more than 20 papers in reputed journals.

Abstract:

In 2013, first year medical students and nurse students of Chiang Mai University were tested for the presence of HBsAg and quantitative levels of anti-HBs. The students whom tested negative for HBsAg and anti-HBs negative or titer <10.0 mIU/ml were called back for 3-dose course of hepatitis B (HB) revaccination. Blood samples were taken at 8-10 months after the 1st dose of HB revaccination. Of 408 subjects, 3 (0.7%) were HBsAg-positive and 332 (81.4%) were anti-HBs negative or titer <10 mIU/ml and 76 (18.6%) were anti-HBs titer ≥10 mIU/ml. 2/248 (0.8%) of the students were test positive for anti-HBc. Among persons who born short after adoption of universal neonatal HB immunization in Thailand; at least 0.8% were infected and recovered from HBV infection, 0.7% became HBsAg carriers and at age 17-19 year-old 81.4% were anti-HBs negative or titer <10 mIU/ml. The young adults whom firstly demonstrated anti-HBs negative or titer <10 mIU/ml required at least 2-dose course of HB vaccination to achieve protective levels of anti-HBs. Among the complete 3-dose course of HB revaccinated subjects, only 5/236 (2.1%) have failure to raise anti-HBs ≥10 mIU/ml. Our data support the need of pre-booster check and HB revaccination to whom received neonatal HB vaccination if long time after that they have opportunities for HBV exposure, e.g., joining healthcare disciplines.

Biography:

Nermeen Nabil Ashoush has completed her PhD in 2015 from Ain Shams University in the field of Clinical Pharmacy and Pharmacy Practice. Also, in 2015 she finished a Diploma in Health Economics and Outcome Research from the University of Washington. She is working as a Lecturer in Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, The British University in Egypt. She is also the Head of the Health Economics Unit, Center for Drug Research and Development, The British University in Egypt.

Abstract:

Background & Aims: Pegylated-interferon α-2a and ribavirin (PIFN/RBV), the current standard treatment for hepatitis C virus (HCV) infection in Egypt is frequently associated with hematological adverse effects, leading to high treatment discontinuation rates. The objective of the present study is to explore the effectiveness of intervening with folic acid (F) and/or vitamin B complex (B) compared with placebo (C) in HCV treatment Egyptian patients for the management of treatment induced deterioration of health related quality of life (HRQOL) as well as hematological parameter. Methods: In a randomized controlled trial, one hundred and sixty subjects were randomly assigned to receive PIFN/RBV in addition to BF, B, F or C. Blood samples were collected at different time points during 48 weeks and at 12 and 24 weeks post treatment for complete blood count and for HCV RNA real time PCR. Short form SF 36V2 questionnaire were used to assess HRQOL at various time during and post treatment. Results: Egyptian HCV patients treated with PIFN/RBV showed deterioration of HRQOL which were correlated with deterioration in the measured hematological parameter. Supplementation with vitamin B complex plus folic acid significantly (P<0.001) decreased the deterioration observed in physical and mental health as well as complete blood count. Supplementation with either vitamin B complex or folic acid were also effective but with lower potency than their combination. Conclusion: BF supplementation can reduce adverse effects of PIFN/RBV therapy in chronic hepatitis C patients, which may improve patients’ HRQOL and their adherence to combination antiviral therapy.

Biography:

Dr Mahmoud Elsebai has completed his PhD in 2011 from Bonn University (Germany) and postdoctoral studies from Oulu Uni (Finland) and Nice Uni (France). He has published more than 20 publications (including patent applicaations) in reputed journals such as J Virology, Med Chem Letters, European J Org Chem and Nat Prod Reports. He is working on chasing hepatitis c virus using ntural compounds and recently in 2016 he has discovered potent and broad spectrum compounds against HCV which published in J Virology. He is a reviewer in many international journals. 

Abstract:

As many as 200 million people worldwide are infected with hepatitis C virus (HCV). About 3-4 million people are infected per year and more than 350,000 people die yearly from hepatitis C-related diseases. In the present study, the water extract of the leaves of the wild Egyptian artichoke (WEA) showed improvement of HCV infection symptoms. Therefore, our study was divided into two main strategies: The clinical investigation of WEA extract on some infected Egyptian patients. The results showed outstanding activity against HCV and its complications such as ascites and jaundice by measuring the PCR and liver functions such as ALT and AST. The phytochemistry of the WEA extract and its subsequent evaluation of inhibition capacity in vitro using cell-culture derived HCV: The chemical investigation of the WEA extract resulted in the identification of six compounds. Importantly, all compounds inhibited HCV infection; compounds cynaropicrin and grosheimol were the most potent among the six. The EC50 were estimated at 1.03 μM, 1.27 μM and 299 μM for compounds 1, 2 and WEA extract, respectively, by using a luciferase-carrying reporter virus. Time-of-addition experiments revealed that they inhibit HCV virus at a time-point during entry. Furthermore, compounds 1 and 2, apart from cell-free infection inhibited HCV cell-cell transmission. Finally, the results showed that compounds 1 and 2 inhibited HCV particles from genotypes 1a, 1b, 2b, 3a, 4a, 5a, 6a and 7a indicating that these compounds inhibit HCV cell entry independently of viral genotype or subtype. Thus, these compounds are promising candidates for the development of new pangenotypic entry inhibitors for the HCV infection. All of these results were applied for patenting.

Biography:

Eman El-Ahwany (PhD) is a Professor of Immunology, Immunology and Drug Evaluation Department, Theodor Bilharz Research Institute (TBRI). She was graduated from Faculty of Science, Cairo University in 1991. She has received her PhD in Immunology in 2001. She has worked as Teaching Assistant and Faculty (part-time) in the Biology Department, the American University in Cairo (1999-2014). She is a Member in the TBRI Technical Office and the TBRI Internal Research Projects Committee since 2011. She is a Member in the European Association of Liver Diseases (EASL). Her field of interest is miRNAs and the epigenetic changes as non-invasive diagnostic and therapeutic tools in HCV-induced liver fibrosis and HCC. She has shared and worked as participant, Co-PI and PI in 20 research projects sponsored by international and national agencies, published 35 research articles in peer reviewed international journals, presented several abstracts in 30 international conferences and supervised 15 MSc and PhD thesis. She has been awarded the TBRI excellence award in 2014. She is the Coordinator of MOU between TBRI and Basque University in Spain (2016). She has obtained Post doctorate fellowships in Germany (2007) and France (2014). She has been awarded the TBRI excellence award in 2014.

Abstract:

Background: In liver fibrosis, miRNAs play an essential role in activating HSCs proliferation, differentiation and migration. To study regulation of genes at the miRNA level is a huge advantage as gene expression, is regulated at an epigenetic level before even proteins get formed. Aim: The aim of the study is to develop a non-invasive diagnostic tool based on measuring the serum levels of different miRNAs in order to detect HCV-induced liver fibrosis at the early stages of the disease. Patients & Methods: Subjects of the current study included 66 cases of chronic hepatitis C (CHC) with early stage of fibrosis, 65 cases of CHC with stage 4 of fibrosis admitted to department of hepato-gastroenterology, TBRI. 35 subjects were included as normal controls. Five main miRNAs (miR-214, miR-221/222, miR-9, miR-125b and miR-128) were measured using real-time reverse transcription-polymerase chain reaction. Results: Circulating levels of miR-214, miR-221/222, miR-9, miR-125b and miR-128 were significantly increased (P<0.01) in cases of both CHC with early stage of fibrosis and CHC with stage 4 compared to control group. Also, there was a significant increase (p<0.01) in CHC with stage 4 of fibrosis group versus CHC with early fibrosis group. Conclusions: Our data suggest that circulating miRNAs could serve as novel biomarkers for the detection and assessment of liver fibrosis.

Biography:

Muhammed Alaa Hammad is currently working as an eminent faculty member at Mansoura University, Egypt. He has extended his valuable service towards the scientific community with his extensive research work.

Abstract:

Background: Hepatitis A, B and C have been encroaching into Egypt's cities in the recent years. Thus, appropriate preventive measures should be taken into consideration. Objective: Clinical level-Knowing all health-workers who have been struck by needle stick injury in the year 2015 in Mansoura University Hospitals and whether they received proper vaccination for Hepatitis B: 140 health-workers were involved. Later, a general awareness talk is done to ensure they are updated on management of possible hepatitis B affliction. Academic level: Awareness has been done to medical students and healthcare workers on 3 major hepatitis in Egypt A, B and C with a total of 903 surveyors. Methods: Clinical level: A survey is given to a health-worker where we ensure confidentiality if struck by a needle and then we aware them of hepatitis B. Academic Level: A pre-survey is given to a medical student/health worker assessing his/her knowledge of hepatitis A, B and C. A general talk targeting certain basic info needed to be known by students and clinicians is then given. A post survey is then given to assess the talk and if it added any of the target's knowledge. Results: 53% of 140 health-workers got injured by a needle stick in the past 12 months only. 68% injured due to individual carelessness besides 81% did not file incident report. Out of 140, 90 were not vaccinated for Hepatitis B and 96% did not receive training in prevention or treatment of needle stick injury. Out of 903 surveyors for general info on Hepatitis 40% answered all questions right in the pre-survey and 90% answered them right on the post-survey. Conclusions: More focus is needed to be put on informing health-workers and medical students on how to prevent needle stick injury and they in general need to be aware of the common types of hepatitis.

Biography:

Gerard E Mullin is a board-certified Internist, Gastroenterologist and Nutritionist. He is an Associate Professor of Medicine and Director of Integrative GI Nutrition Services at The Johns Hopkins Hospital. He is as an authority in nutrition and gastroenterology. He teaches medical professionals at international conferences on the role of nutrition and lifestyle and the gut microbiome in digestive health outcomes. He is the author of several professional desk references and trade books including The Gastrointestinal and Liver Disease Desk Reference.

Abstract:

Vitamin D and its role in immunity, inflammation and chronic disease pathogenesis has been the subject of many scientific investigations. The progression of the chronic liver disease (CLD) to cirrhosis is the result of an imbalance between the production and dissolution of the extracellular matrix. Development of liver fibrosis in the setting of chronic hepatic inflammation and injury is orchestrated by many cell types, including hepatic stellate cells (HSCs). The significance of vitamin D deficiency in CLD and cirrhosis is emerging in the literature. We systematically evaluated the literature for the relationship of vitamin D to fibrogenic liver disease by utilizing PubMed, SCOPUS, Embase, Cochrane Database, OVID and Lilacs as part of a search protocol. Low vitamin D status predicts progression of non-alcohol fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH) and then to cirrhosis and appears to predict survival. Low vitamin D status contributes to resistance to anti-viral therapy for viral hepatitis with improved response rates in those having vitamin D sufficiency. This session will review the literature, the putative mechanisms for vitamin D’s apparent effect on CLD outcome and the importance of monitoring of serum 25-hydroxyvitamin D levels for prognostication and intervention.